23rd Parliament · 1st Session
Mr. SPEAKER (Hon. John McLeay) took the chair at 2.30 p.m., and read prayers.
Mr. BIRD presented a petition from certain citizens of the Commonwealth of Australia praying that the House will amend certain parts of clause 27 of the Matrimonial Causes Bill dealing with grounds for the dissolution of marriage.
– Mr. Speaker, in questioning the Minister for Trade I revert to the question I asked yesterday. No doubt the Minister has anticipated the asking of another question to-day. I ask him whether he will state to the House shortly the effect of the changes in shipping freights. Secondly, will he now consider, in the light of those changes, the wisdom or desirability of legislating on the subject and establishing, to deal with overseas trade, an independent tribunal whose function would be to fix reasonable and fair rates for all concerned?
– With regard to the first part of the right honorable gentleman’s question, I am in a position to give the information. I had proposed, in order to avoid eating into question time, to give this information towards the end of questions. If that course is acceptable I will do so.
– That is quite acceptable. Will the right honorable gentleman give the information in the form of a statement?
– If that is desired, I will give it in the form of a quite short statement.
Regarding the latter part of the right honorable member’s question - his proposal that the Government might establish a tribunal - that suggestion, of course, raises a question of policy which it would not be customary to reply to at question time. However, I make the observation that it would be novel to impose conditions upon people who are not residents, of Australia and are really not under the: control of the Australian Government.
– Can the right honorable gentleman make a copy of the freight rates available to honorable members?
– Yes. I will do that.
– Will the PostmasterGeneral re-examine the urgent needs of the Morley Park area of my electorate for better telephone facilities? Further, will the honorable gentleman consider my suggestion that the telephone needs of this rapidly growing district could be met by the installation of a portable or temporary telephone exchange?
– As a result of previous representations, the rapid development of the Morley Park area has been considered by the department. For the purpose of giving relief as quickly as possible it is the intention of the department to install an automatic exchange there for the use of residents. I am informed, Mr. Speaker, that not only will that give quite rapid relief to the subscribers in that area, but also that it will assist the subscribers in the adjacent area of Maylands.
– My question is directed to the Minister for Trade. I desire to know whether it is a fact that the importation of rayon has increased in quantity by 2,600 per cent., comparing the estimated imports for the current year with those in 1950-51, the year preceding the introduction of import licensing. Also is it a fact that in the same period the importation of manmade fibres other than rayon has increased by 1.400 per cent? If so, how does the Minister explain such extraordinary increases in these imports in a period when import restrictions are in existence? Will he state what, to his knowledge, has been the effect upon Australian industry and employment?
– Clearly, I am not in a position to have in my mind with any precision the details of increases in the imports of rayon and of other man-made fibres in the period stated. But I do observe that man-made fibres other than rayon - terylene, dacron and orion, I think - have come into popular use since 1950-51. Therefore, I think that the percentage increase probably is not pertinent. Imports of rayon have been subject, of course, to the existing tariff. Rayon yarn, the filament from which certain rayon fibres are produced, and rayon piecegoods, all have been reported upon by the Tariff Board, upon the recommendations of which the Government has acted from time to time.
As to the effect on employment, rayon is used for garment-making in this country, of course, and I should think that it replaces cotton much more than it replaces wool. I have no doubt that employment in the textile-fabricating or garment-making industry would have been devastatingly affected if the Government had not seen to it that it was possible to import silk piecegoods and yarn, cotton piecegoods and yarn, and man-made fibre piecegoods and yarn, as needed to satisfy the Australian consumer demand and provide employment in the garment-making industry.
– I direct a question to the Minister for Trade. The right honorable gentleman has just said that he will make a statement on the subject of shipping freights. I ask him whether he will be able to give, in that statement, precise details of the effect of proposed freight rates on exports by Australia’s all-important apple industry?
– I do not think I can undertake to give precise details, because all of the factors have not been made available publicly, although they have been available to the Australian negotiating interests, which, indeed, have applied them. I can say, shortly, that the freight on fresh apples and pears will not be increased for the coming season. I shall give fuller particulars later.
– I desire to direct to the Prime Minister a question which relates to the standardization of railway gauges.
Has the right honorable gentleman’s attention been directed to a statement in which the Premier of South Australia is reported as having said that current Commonwealth proposals for the standardization of railway gauges in South Australia were a complete departure from the original agreement; that South Australia might have to find out from the High Court of Australia whether the agreement with the Commonwealth on rail standardization in South Australia meant anything; and, further, that the South Australian Premier could not help but feel that, at the moment, there was no support in the Federal Cabinet for the Cockburn to Port Pirie project, notwithstanding that it was the subject of a firm agreement between both parties? The South Australian Premier has invited the Prime Minister to make a frank statement of the Commonwealth’s intentions, but this he has not been able to get. In reference to the Mount Isa project, the Premier states that the-
– Order! The honorable gentleman must ask his question.
– I shall leave out the statement about the Mount Isa project. I ask the Prime Minister: Will he instruct the federal rail authorities to confer with the South Australian authorities so that this national project of rail standardization in South Australia can be advanced without further unnecessary delay?
– I would be immeasurably assisted if the honorable member would put that question on the notice-paper.
– I desire to ask a question of the Minister for Trade. There have been recent statements overseas about the sale of 4,500 tons of butter by Canada to the United Kingdom in what were said to be special circumstances. Will the Minister inform the House what were the special circumstances? Was Australia consulted before the sale took place? Will the terms of the sale act to the detriment of traditional suppliers of butter to the United Kingdom market?
– Recently, due to the drought conditions in Europe, there has been a shortage of butter in the United Kingdom and in other European markets - a shortage which Australia and New Zealand have not been able to overtake. The Australian Government was consulted by the United Kingdom Government and by the Government of Canada about the proposed sale from Canadian stocks of butter to the United Kingdom. It was agreed by the Australian Government - and I am informed that the Australian Dairy Produce Board concurred - that in these circumstances there would be no objection to the sale from Canadian reserves of 4,500 tons of butter to the United Kingdom. This will not act to the detriment of Australia or of other traditional suppliers to the United Kingdom, having regard to all the circumstances that exist.
– In view of the unemployment which at present exists in the lead and zinc mining industry, will the Minister for Trade make new representations to the United States Government to lift the restrictions on imports of Australian lead or, alternatively, to adjust existing quotas which affect Australia’s exports of lead to the United States more than exports from other countries?
– The Government has kept continuously before the Administration of the United States the views that we hold on, and the interests that are affected by the United States quota restrictions on importations of lead and zinc - particularly Australian lead and zinc. In recent years, lead has been our principal dollar earner and the very severe quota restrictions imposed by the United States have worried both the industry and the Government very much. They have been the subject of personal representations by me on two occasions in Washington and of continuous diplomatic representations. Apart from that, the lead and zinc exporting interests of the world have combined during the last year to limit the quantity of lead and zinc presented to the international market so that, by equating the supply to the demand to some extent, a profitable basis of prices might be re-established. I think we can observe, from the present London metal exchange quotas for zinc in particular, that that objective has been achieved and that a certain distance at least has been gone in respect of lead. It is possible that the international lead and zinc industry may wish to reconsider its voluntary restriction arrangements soon because those existing arrangements have resulted in a firming of the market situation.
– Will the Treasurer consider altering the provisions of the relevant income tax legislation which limit a taxpayer who has, in honest error, overstated his income, to a period of three years after the error was made in which to claim a re-assessment and a refund of tax, while allowing the Commissioner of Taxation to go back for as many years as he wishes, without limits, where a taxpayer has understated his income and is to be re-assessed for the purpose of claiming additional tax? I ask this so that the taxpayer and the Taxation Branch may be placed on the same basis in this connexion.
– I could not give an answer offhand to the honorable gentleman, but I will undertake to examine the terms of his question and send him a considered reply when I am in a position to do so.
– I ask the Treasurer a question without notice. Has the right honorable gentleman given any further consideration to the request I made prior to the presentation of the Budget that persons who have lost limbs or the use of limbs through accident, amputation or poliomyelitis should have the same concession as limbless ex-servicemen with respect to sales tax on motor cars? Those people, through their own courage, are still gainfully employed in the community but are often embarrassed when using public transport owing to their awkwardness and slowness.
– I assure the honorable member that careful and sympathetic consideration was given to his request at the time of the Budget, but the Government decided as a matter of policy that it would not open up the sales tax legislation at that time. I have listed the matter for consideration when the sales tax law is next under general review.
– Would the right honorable gentleman look at the suggestion in the meantime as a matter of urgency?
– I have said that 1 will look at it when sales tax is next under general review. A host of matters have been brought to our notice in relation to sales tax and all of them have points that are worthy of consideration. If you open the door in one direction it is not easy to shut it against other people who also have strong claims, although the special claim on our sympathy and our consideration in the matter put forward by the honorable gentleman is not under-estimated.
– I ask the Minister for Trade a question. Does the Government intend to send a representative to give evidence before the current United States commission into increased tariffs on woollen textiles with a view to securing conditions in which Australia could hope to earn more by exporting the finished article than it can by selling her raw wool to Japan and the United Kingdom and allowing those countries to reap the profits from manufacture?
– The Government is very interested and concerned at the level of United States tariffs, both on raw wool and on woollen textiles. But the Government itself has not, as a matter of practice, sought to present evidence before the United States tariffs commission and would not propose to do so at this stage. In similar circumstances the United States administration, as a disinterested party, has never sought to give evidence before the Australian Tariff Board. But through channels other than direct evidence, the Government is at pains constantly to make representations, both direct to the administration and in discussions in the General Agreement on Tariffs and Trade, that explain Australia’s interest. Of course, the Australian textile industry is free, either of its own accord or through those parties in the United States with whom business is done, to make representations. The same applies to the British textile industry. That opportunity is taken and I have no doubt that it will be taken again.
– I ask the Minister for the Army whether it is a fact that Army chiefs have described national service training as a waste of man-power, time and money, and said that if permanent personnel were to be taken away from this unproductive duty, the armed services would be considerably strengthened. Does that statement reflect the view of the Government in regard to national service, or does the Government intend to continue with this extravagant waste in the light of what the top brass have said? Will the Minister say whether the Government intends to abandon national service training before the next intake of trainees, thereby allowing those trainees to continue in their employment without disorganization of the industries in which they are employed?
– I read in a newspaper recently a report of an alleged statement by Army generals about the national service training scheme. The report was completely untrue. The alleged statement does not represent the opinion of the Army at all. The scheme has been very successful. As to the remainder of the honorable member’s question, I gave an answer to a similar question two or three weeks ago, and I do not propose to add to it.
– My question is directed to the Prime Minister. By way of preface I refer to three relevant facts. The Department of National Development has stated, first, that the number of dwellings constructed in 1958-59 was 84,000; secondly, that the accumulated shortage of dwellings, due to the depression and the war, will be overcome with:n the next two years; and thirdly, that the number of dwellings needed annually in three years’ time will be about 60,000. My point is that in three years time, if the estimates of the department are correct, there will be considerable surplus capacity in the building industry. In view not only of the social but also of the economic requirements, has the Government yet considered methods of tackling the next phase of the housing problem? In particular, will the Prime Minister consider asking the Minister for National Development to confer with State Ministers regarding the making of a start now on the complex and lengthy task of preparing slum clearance schemes, and will he give thought to the financial implications so far as this Government is concerned?
– The honorable member raises, as he realizes, quite large issues, to which I would not desire to give an offhand reply. I will discuss the suggestions made by him with my colleague, the Minister for National Development, and, if necessary, with my other colleagues.
– I desire to ask the PostmasterGeneral a question. The Postal Workers Union has been negotiating for a number of years with the object of having footwear issued to postmen to complete their uniform. The Postmaster-General realizes, no doubt, that postmen travel many miles each week on walking or bicycle rounds, and that as a result they are involved in heavy expenditure for the repair and replacement of footwear. Has the PostmasterGeneral yet made a decision in this matter? If he has, and if his decision has been favorable, when can postmen expect to be supplied with these overdue uniform components?
– The Government decided some months ago that footwear would be provided for certain of the Post Office uniformed staff. An amount to provide for this was included in this year’s estimates. I should have thought that the honorable member would have noted that fact when the Estimates were under discussion. The union authorities were advised of this fact some considerable time ago, and I know that discussions have taken place between officers of my department and senior officers of the union as to the method of providing this footwear.
– Is the PostmasterGeneral aware that the new post office at Broome in Western Australia - a very fine building anc! a great credit to the Minister’s department - is not equipped with airconditioning?
– Neither is the one at Maroubra!
– In view of the fact that the north of Western Australia experiences extreme heat and humidity - a fact of which the honorable member for Kingsford-Smith would not be aware - will the Minister consider having this post office air-conditioned, and will he also provide for air-conditioning to be specified for future post offices in tropical and sub-tropical areas?
– I am glad to hear the complimentary remarks of the honorable member for Kalgoorlie regarding the new post office at Broome. I think the honorable member will agree that the provision of this office, and also the recent provision of radio-telephone communication between Derby, Broome and Perth, the ceremony to initiate which service was attended by him and other honorable members, indicate that the department is doing all it can to improve telecommunication and postal services in that area.
Regarding the air conditioning of the Broome Post Office, it so happens that I saw that post office about four or five years ago and realized the need for an improvement in the then-existing conditions. Although it is not usual to provide air conditioning in post offices generally, I know that some attention was given, in the designing of the Broome Post Office, to the provision of such facilities. However, I am informed that the electric power available at Broome would not be sufficient to operate a full air conditioning system and that the provision of anything less than this would not be satisfactory. Therefore the Department of Works, in designing this building, set out to try to provide certain features which would enable the intake of heat from outside to be minimized to the greatest extent in the hope that this would provide conditions which would be reasonable for those working in the building. I hope that later I may have some report as to the success or otherwise of that attempt.
– Has the Minister for Healths seen the remarks of Dr. Lindell, Chairman of the Victorian Hospitals and Charities
Commission, to the effect that Great Britain was showing a clean pair of heels to the rest of the world in hospital care and that Britain’s national health scheme made the task of caring for old people much easier than it is in Australia? Will the Minister confer with Dr. Lindell with a view to securing information from him on ways and means of improving these services in Australia?
– I have not seen Dr. Linden’s statement but I am sure that the honorable member will be aware that the standards of hospital care are primarily a responsibility of State governments and that they are supported, financially, with very large sums of money by the Commonwealth Government.
– Is the Minister for Territories aware that trade union circles in Darwin claim that in the handling of cargoes there costs are approximately only 20 per cent, chargeable to labour and about 80 per cent, to other stevedoring charges? Does the Minister consider that this is a reasonable proportion of costs? Is he aware of any official requests having been made for an investigation into the cost of handling cargoes in the port of Darwin?
– In the Legislative Council for the Northern Territory some time ago, attention was drawn to the problem presented by high handling costs in the port of Darwin. As a result of this, with the collaboration of my colleagues, the Minister for Shipping and Transport and the Minister for Labour and National Service, an inquiry into stevedoring costs is being conducted at the present time.
– Is the Minister for Social Services aware of the persistent and continuing appeal that is being made through letters to newspapers and through public meetings for the speedy alleviation of the means test in respect of social service pensions and the pensioner medical service? Can the Minister assure the Parliament that a full investigation, as recently promised by the Prime Minister, is now being made of the various aspects of this problem? If investigations are under way, can he predict the time when specific recommendations will be available?
– I am aware that representations have been made from time to time for a further liberalization of the means test, with respect to both income and property. I remind the honorable member for Barton that ever since this Government was elected ten years ago, the means test with respect both to income and property has been liberalized from time to time. By that very process, the Government has included within the general scheme of social services countless thousands of people who had previously been excluded. I hope that that splendid purpose will continue; and it can only continue consistent with the financial capacity of the Australian people to bear the additional cost.
– Will the Minister for Trade explain the present position of our flour export market? Is he not disturbed that we have lost our position as a leading world exporter of this commodity and that we have lost trade around the perimeter of the Indian Ocean, which for many years was accepted as our traditional market?
– The condition of our export trade has been giving the Government considerable concern for several years. As the honorable member, who interests himself in this matter, mentioned, our trade in flour has very largely been with countries around the Indian Ocean. However, I am glad to inform him that, as a result of negotiations over the past year, very substantial advances have been made in recovering trade opportunities and in consolidating such opportunities as we have. I shall briefly remind the honorable member of them.
Although Ceylon was the principal export market for Australian flour for a period of years, we made no sale at all for sixteen months, until three or four months ago, when, as a result of negotiations, the Government of Ceylon forthwith bought 30,000 tons of flour and engaged in a subsequent trade treaty to buy 100,000 tons of Australian flour a year. That undertaking is being honoured. Malaya was a very important market, and trade negotiations have produced an assurance of a sale there of 80,000 tons of Australian flour a year.
Negotiations have proceeded with Indonesia, but we have encountered the problem of American gift flour and other noncommercial transactions such as subsidized flour from European countries. However, I am confident that, as a result of recent negotiations, Australia will be assured of a substantial trade in flour, although the level may not be as high as we would wish. A mill has been built in the Philippines by local interests, at the instigation of the Government there, and this, of course, will subtract from our trade.
The conclusion of a trade treaty with Germany in the last few weeks has had the result of the German Government giving an assurance there would no longer be grounds for complaint that we would suffer serious damage to our markets from German flour. The German authorities are taking steps to implement these assurances. This arrangement with the German Government will give Australia a new opportunity to sell flour in the Indian Ocean area. We have been arguing with the Government of France, directly and through the General Agreement on Tariffs and Trade, for some time. These discussions will proceed, and we hope that we will eventually have the same success in discussions with France as we had with other governments.
– My question, which is addressed to the Minister for Territories, is supplementary to a question asked earlier by the honorable member for Bowman and deals with handling charges at the port of Darwin. The Minister stated that an inquiry into this matter was proceeding. I ask him whether the committee includes representatives of the public, the trade unions and the business community, because I feel that only by the inclusion of such representatives can a true assessment of the position be obtained.
– The inquiry at present being conducted is not a public inquiry by a public committee. It might more pro perly be described as a preliminary investigation to discover some of the basic facts of the situation so that the Government can make up its mind as to what further steps it should take.
– My question to the Minister for Trade relates to the new clause that has been inserted in the International Wheat Agreement under which deals associated with the disposal of surplus wheat are to be recorded. Is it a fact that large traditional markets have been lost to Australia by the dumping of American and Canadian wheat which is sold under noncommercial terms? For example, I understand that our sales to India have dropped from 35,000,000 bushels annually to about 500,000 bushels annually. Is it a fact also that surplus wheat is sold to the consumers in the under-developed countries at the same price as commercially sold wheat? Is it intended that the Internationa] Wheat Council will try to limit noncommercial trading, or will it merely record such deals?
– The International Wheat Council and the International Wheat Agreement are instruments to deal with commercial transactions in wheat, and the negotiations and discussions that have proceeded regarding non-commercial transactions have been outside the scope of the International Wheat Agreement. But as there is clearly a relevancy, it has been regarded as convenient - indeed, essential - that there should be some form of recording non-commercial transactions in wheat. That is the matter to which the honorable member has referred.
The Government of the United States of America, out of its generosity, has been making available large quantities of wheat and other foodstuffs to the markets to which the honorable member has referred, and the United States Administration has been brought to understand, I think more than anything else by the representations of the Australian Government, that its actions have produced problems that warrant serious examination. From that, and from a recent conference that was convened by President Eisenhower, a body known as the Wheat Utilization
Committee has been established which will be a standing body for consultation in the event of governments wishing to make noncommercial disposals of wheat. The arrangements that are implicit in this set-up are clearly understood by the governments of countries such as India which desire to receive wheat, flour and other products on non-commercial terms. I think it can be said that this is an acceptable and a practical arrangement, having regard to all the circumstances.
What we describe as PL.480 deals by the United States are actually sales for payment in the currency of the country concerned. It seems to be a matter for the receiving government as to whether it gives away the wheat or sells it in its own country at a price determined by itself.
– 1 ask the Prime Minister: Will he ascertain what stage has been reached in consideration of the proposal that the salaries of secretary-typists employed by members and senators should be reviewed and increased? Recognizing that secretary-typists share the increased work and responsibility which recently justified increased salaries to members and senators, will the Prime Minister do whatever he can to hasten a decision in this matter?
– I am not precisely aware of the present stage of the matter, but I will find out and advise the honorable member.
– My question to the Treasurer relates to the recently reported unanimous decision of the board of the International Monetary Fund that there was no longer any justification on financial grounds for trade discrimination against the dollar area, a decision in which, presumably, the Australian director concurred. First, has the Treasurer given clearance to his colleague, the Minister for Trade, to cease discrimination as far as financial factors are concerned? Secondly, will this question, and the acceptance of the obligations of Article VIII. of the Articles of Agreement of the International Monetary Fund, be raised during the forthcoming discussion of Australian officials, in Australia, with officials of the fund?
– As I think all honorable members are aware, one of the features of the post-war period has been the problem experienced by most countries of a shortage of dollars, with the need to maintain some discrimination against dollar goods. That situation, as I explained in some detail yesterday, has been very notably transformed by the movement in the balance of payments over the last couple of years, the United States having had a national deficit of about three billion dollars in the year before last and expecting to have a deficit of the order of four to four and a half billion dollars in the current year. As a consequence of that movement there has been increased pressure from the United States, and to a lesser extent from Canada, for the removal of restrictions by those countries which still maintain them.
Australia has been proceeding in that direction, and was able to state at the recent meeting of the International Monetary Fund that we are, to employ the jargon of the day, about 90 per cent, liberalized and are looking to a progressive removal of remaining restrictions. The question of the movement of countries still employing the transitional provision of Article XIV. to Article VIII. was discussed by the recent Commonwealth Finance Ministers’ Conference in London, and further discussions are now proceeding on that matter inside the Commonwealth governments concerned. However, I am not in a position at this point to state to the honorable gentleman what I am sure he will appreciate is a substantial matter of Government policy, but I can tell him that the subject is actively under the Government’s consideration.
– My question is directed to the Prime Minister. Has the right honorable gentleman paid any attention to the activity of the expert committee appointed to inquire into all aspects of research into the uses of coal, whose appointment was announced by the acting Prime Minister on 26th June last? In view of the committee’s research in Australia and overseas being directed along lines intended to put it in a position to recommend the initiation or encouragement of some plan designed to lead quickly to an increased demand for coal, can the Prime Minister say whether any final or interim report is yet available as the result of the establishment of this expert committee?
– I have not yet seen a report, but I am grateful to the honorable member for directing my attention to the matter again. I shall find out whatever I can about it and will reply to him.
– I ask the Treasurer a question. During the Treasurer’s recent absence overseas the Prime Minister indicated that shortly an announcement would be possible with respect to the terms of reference for the committee of inquiry into Australian taxation laws, and also about the personnel appointed to that committee. Is the Treasurer in a position to provide the House with additional information?
– I can assure the honorable gentleman, Mr. Speaker, that action has been proceeding towards the objective he has mentioned, lt is not merely a question of determining the terms of reference; we hope at the time of announcing these, also to announce publicly the personnel of the committee. The Prime Minister and I recently conferred with senior members of the various institutes of accountants seeking their co-operation in the way of proposing a panel of names to us from which a selection might be made. We have also been making inquiries in other quarters in order to produce the kind of balanced and representative committee that, as I explained earlier, would be the Government’s goal. I hope that we shall not defer too much longer an announcement of the details sought by the honorable gentleman.
– My question is directed to the Minister representing the Minister for Civil Aviation. Is it a fact that hostesses on Trans-Australian Airlines aircraft have been directed to canvass passengers for engagements for a private hire-car company operating at Kingsford-Smith airport in Sydney? If so, does the Minister agree that this is an added duty imposed on the already overworked and under-paid hostesses, and will he take steps to see that this favorable treatment to this private hire-car company is discontinued? Is it also a fact that two-way radio from aircraft to terminal is used to complete the engagement of hirecars by passengers, thus placing an additional strain on the radio operators? Will the Minister take steps to clean up this racket at Mascot and require private hirecars to ply for hire on equal terms with taxi-cabs, which are operated mostly by exservicemen? Also, will the Minister take steps to see that the approaches to the terminal are kept clear for passengers and travellers and not cluttered up by private hire-cars?
– I shall convey the honorable member’s question to the Minister for Civil Aviation in another place, but I expect that the Minister’s answer will be, “ No “.
– by leave - The Leader of the Opposition (Dr. Evatt), as well as a considerable number of members of all parties in the Parliament, have evinced a great interest in the level and the determination of overseas shipping freights. I am now able to give the following information to the House: - Shipping discussions were recently concluded in Sydney which dealt with freight arrangements in the AustraliaUnited Kingdom-Continent Shipping Conference. The commodities affected were wool, refrigerated cargoes, fresh fruit, and “ general “ - that is, packaged - cargoes. Bulk cargoes, for example, wheat, other grains, sugar and ores and concentrates, were not affected by these negotiations.
There were two major results of these negotiations. First, the so-called “ formula “ arrangement in this trade was revised; and secondly, it was agreed that there would be no variation in freight rates before September-October, 1960, when these freight rates are again due for review. The “ formula “ provides for the shipowners in this trade to receive a return sufficient to cover their costs and to provide an agreed return on their invested capital.
The original formula, negotiated in 1956, provided for a 12 per cent, return to owners on a capital figure calculated on the original cost of each ship as written down over a 25-year period. The rate of return has now been reduced to 10 per cent, per annum, with special arrangements to reduce the charge on freight rates at a time, such as the present, when, by reason of the post-war replacement programmes, the vessels engaged in the trade are particularly young. The revised formula accordingly provides for the basic rate of 10 per cent, to be applied to a figure determined by adopting what would be the written-down value of each ship after twelve and one-half years’ use. A lower rate of return, namely, 6 per cent, per annum, is then applied to the amount by which the actual capital employed, computed by reference to the actual cost and age of each ship, exceeds the figure to which the basic rate of 10 per cent, has been applied.
The other details of the formula - for example, the depreciation provision allowed to owners when costs are being determined - have not been made public, but, of course, they are known to the Australian interests which have been negotiating.
In his statement about the outcome of the negotiations, the Chairman of the Federal Exporters Oversea Transport Committee has mentioned that it has been calculated that, on the new formula, a freight rate increase of about 6 per cent., as compared with an increase of about 12 per cent, under the old formula, would have been warranted. However, as I have already indicated, it has been agreed that there shall be no variation in freight rates before SeptemberOctober, 1960. The new formula will be applied in the two-year period 1960-61 and 1961-62. Its terms will then be reviewed in the light of circumstances ruling in 1962. Shipowners, in return, agree to continue to provide a guaranteed service to shippers.
The entire negotiations were held under the auspices of the Australian Oversea Transport Association. The Federal Exporters Oversea Transport Committee, a body of 26 representatives of major produc ing and exporting interests, conducted the negotiations on behalf of Australian interests. The chairman of this committee has stated that the agreement represents, on the whole, a reasonable basis from the point of view of both shipping companies and shipper interests. Successive governments since 1929 have recognized that the determination of rates of freight in the United KingdomContinent conference should be left, within the framework of the Australian Oversea Transport Association, to the parties directly concerned - namely, the producer-shipper interests and the shipowners. In 1953 and 1955, when negotiations became deadlocked, the Government agreed to fulfil the role of a fact-finding mediator. In 1957, the Federal Exporters Oversea Transport Committee was reorganized in order to widen its representation and give a better voice to producer interests. The Government’s assistance was sought in connexion with that re-organization, and was given.
– by leave - I do not wish to detain the House for more than a minute or two. I wish only to point out that we find continually recurring this situation in which there is a dispute between the shippers and the shipowners in regard to a matter which is of such great importance not only to those two great groups but also to the public of Australia. I submit to the Government and the House again that there must be some method of fixing a reasonable and fair rate for all concerned. No question of constitutional power is involved, because this is clearly a matter relating directly to overseas trade. I suggest that unless it is tackled by the Australian Parliament we shall never get satisfaction in the matter.
My colleague, the honorable member for Lalor (Mr. Pollard), will bring this matter before the House at a later stage. This is the point which I wish to make at the present time: It is completely useless to have these agreements. The Government neither is a mediator nor takes responsibility for fixing rates. These private interests meet, and these arrangements endanger the public interest in the way that I have mentioned.
The purpose of my statement is to point that out, and I thank the House for affording me the opportunity to make it.
Debate resumed from 10th November (vide page 2524), on motion by Dr. Donald Cameron -
That the bill be now read a second time.
.- Mr. Speaker, last evening, I endeavoured to make four main points in dealing with this bill. The first of these was that Labour is opposed in principle to this so-called voluntary health scheme which compels the payment of taxes, on the one hand, and membership of a private benefit organization, on the other, in order that benefits may be gained from what is compulsory taxation. So, first, Labour is opposed in principle to this kind of system.
Secondly, although we agree that the scheme should be conducted efficiently and economically, we say, in our concern over the substantially increased costs, that we should have regard also for the considerable benefits and savings effected by the scheme. For instance, it is estimated that the wider availability of costly drugs has meant a saving of about £30,000,000 in the last six years. I do not say that this scheme is the sole reason for that saving, but it plays a prominent part in it. It is asserted that a saving of about £30,000,000 in the last six years has been made possible by the reduced demand for hospital accommodation, not only because it has not been necessary to build hospitals that would otherwise have had to be built, but also because the average time spent in hospital has been very substantially reduced. I think I mentioned last night that, not many years ago, the average time spent in hospital by a patient was nine days. This has now been reduced to three and one-half days.
Another aspect of this saving, of course, is that absenteeism from work owing to sickness has been substantially reduced. One could expect, as a consequence, a substantial contribution to national productivity owing to the better health of the community. Apart from these main aspects, Mr. Speaker, there is the humanitarian aspect, which should occupy first place. I refer to the reduction in the pain and suffering experienced by people who are un fortunate enough to become ill. I make the further point that the Government has been preoccupied with the increasing costs of pharmaceutical services under the other aspects of the national health scheme and has not been interested enough to look at, or to attempt to make any assessment of, the benefits and savings deriving from the scheme.
Last evening, I made the third point that the proposed 5s. charge in respect of the making up of prescriptions, a good many of which were hitherto free, will be a very harsh burden on some people, and especially, I submit, on the family man and on those aged sick people in our community who are not covered by the pensioner medical service. At question time this afternoon, I raised the whole matter of the means test in respect of pensions. Although the number of people eligible for pensions has been increasing, the fact is that about 51 per cent, of those who are eligible for the pension by age are denied it.
Linked with this denial of the pension is the denial of benefits under the pensioner medical service. About 70,000 of those who receive the pension are disqualified from receiving benefits under the pensioner medical service because the 1955 amendment of the National Health Act introduced by this Government imposed a means test by providing that any person entitled to a pension who received additional income of £2 a week was to be denied benefits under the pensioner medical service.
Many of these people are recipients of superannuation as a result of their thrift. The penalty for their thrift is to be denied a full pension and, in addition, to be denied the pensioner medical service at a time of their life when they are prone to sickness, and therefore may need hospital care and drugs. Worse than that, under this legislation they will have to pay, along with the rest of the community, for pharmaceutical benefits that hitherto were free.
The fourth point that I intended to make was to urge that, as a consequence of what I have said, at least we should make a start on abolishing the means test which was imposed in 1955 in respect of the pensioner medical service. I consider that that means test should be abolished immediately. This would not cost over much to the community. In view of the persons who would benefit - the aged citizens - I think that the community would be only too pleased to bear that cost.
I want to say a little more on the hospital aspect of the national health scheme. The bill before us does propose to abolish the requirement that all persons over 65 years of age shall automatically transfer to the special fund part of the medical benefits scheme. Those persons are now to be allowed to remain in the ordinary fund in respect of medical benefits, but not in respect of hospital benefits. This is a serious imposition upon them. At best, people who are in the special fund can get only £12 12s. per week towards the cost of their hospital treatment. The Minister for Health (Dr. Donald Cameron) nods his head.
– The Minister shakes his head.
– I will be interested to hear the Minister’s explanation of this matter. So far as I can see, the maximum amount that chronically ill people, people with pre-existing illnesses, and people transferred to the special fund, can get is £12 12s. per week. That has been the experience of friends of mine who have gone into hospital and made bitter complaints about this situation because they had been paying into funds for many years. It has been reported frequently in the daily newspapers recently that people who have been paying into a hospital fund at a high rate for many years suddenly find that, because they are over 65 years of age, they have been transferred to the special fund, and that, therefore, they are eligible only for the restricted amount provided by the special fund and not for the amount provided for in the table under which they had contributed for many years. If that is not true, I will be very glad to hear the Minister say so. My statements are based on information from a hospital benefits fund and from the Department of Health.
Even worse, in my opinion, is the position of persons who cannot get into what is called an “ approved hospital “, under the act All that they get is 8s. a day from the Commonwealth, but if they happen to be in a fund, they can get £7 per week, the whole of the £7 coming from the Com monwealth. In order to get the Commonwealth benefit they are obliged to belong to a fund, but the fund gives them nothing. Not a penny! I cannot see the reason for this.
The reason given for the elimination of the provision that persons over 65 years of age shall automatically be transferred to the special medical benefits fund is that the cost to the funds has not been nearly as much as was anticipated. In other words, the calls by persons over 65 on medical services has not been as great as was anticipated. I am wondering why similar action was not taken in respect of hospitals. Why should people of 65 years of age and over, if they so desire, not remain in an ordinary fund and pay for the ordinary hospital benefits? At present, even people who have been contributing to a hospital fund for many years in respect of themselves and their dependants are transferred to a special fund when they become 65 years of age. A payment of £12 12s. a week is totally inadequate to meet hospital bills. Many of these old people cannot get into public hospitals. They are the ones whom the public hospitals will not have because so many of them are long-term patients. Therefore, they have to go into private hospitals and there they have to pay at least £16s 16s. or £17 17s. a week for even the cheapest accommodation. So, the reimbursement of £12 12s. is quite inadequate for their purposes.
The position of elderly people as far as hospital accommodation is concerned is acute. Often, in desperation, they have had to be put into mental hospitals. They should never have to be in those places. That point is made in the report of the Inspector-General of Mental Hospitals in New South Wales for the year ended 30th Tune, 1958. This kind of remark that has appeared in each report of the InspectorGeneral in recent years in respect of elderly people is as follows: -
For some years now I have expressed my concern at the very high percentage of elderly people who are committed to the mental hospitals for treatment. I have stated that many of these people are only slightly deranged and suffering only from the consequences of growing old. Certification and admission to a mental hospital seemed to be an unnecessarily harsh step to take with far too many of them. Unfortunately the position was no better last year.
He goes on to say that 31 per cent, of the people admitted to mental hospitals were over 60 years of age.
The reason that they are put in these hospitals is, first that they cannot gain admission to a public hospital. Secondly, in many cases, they cannot possibly afford to pay for a long period in a private hospital. The only other alternative is to put them into a mental hospital. Bad as that is, those of them who receive age pensions are denied those pensions when they enter the mental hospitals, the upkeep of which is paid for by the State, although some capital expenditure is contributed by the Commonwealth.
– That was a Labour Government arrangement.
– I do not care whose arrangement it was. It is a pretty bad one to sustain. I hope that we are not going to go back ten or fifteen years for a criterion of what we should do in this age. We are long past the time of rehabilitation for most of the ex-servicemen and, therefore, could do something for these people who are denied the pension. The State is also denied a proportion of their pension for their upkeep, which costs more in a mental hospital than it would in an ordinary hospital. As far as I know, these people are also denied coverage under the special fund provisions of the national health scheme. I very much agree with the statements of the Reverend H. Hawkins, Superintendent of the Leichhardt Methodist Mission, He said that geriatric hospitals - hospitals dealing with the problems of aged persons - are perhaps our greatest need for the aged in Australia to-day. Anybody who has any sense of responsibility for the welfare of our aged people must agree with that statement. I suggest that the Government should co-operate with the States, as it has done in respect of mental hospitals, to create special hospitals in the larger communities solely for the treatment of aged people. Those hospitals should be reserved for and available to aged persons in order to bring some reality to the pensioner medical service in giving free public ward treatment to our aged people. Where it is not possible to create a special hospital for the purpose, special wards should be reserved in public hospitals so that our aged people may receive the specialist care that they need. Where people must enter private hospitals the Government should pay them a subsidy by way of a contribution equal to the cost of public ward treatment, which the Government would pay if they were treated in an ordinary public hospital.
I do not know what will happen to the aged and senile under the bill now before us.
– Order! The honorable member’s time has expired.
Debate (on motion by Mr. Stokes) adjourned.
In Committee of Ways and Means:
– I move -
That, in this Resolution, unless the contrary intention appears -
State administering the Act.
That a charge be imposed on fruit -
November, One thousand nine hundred and fifty-nine, to a cannery; and
accepted at the cannery as of canning quality or taken into the cannery for use in the production of canned fruit.
Canned Fruit Sales Promotion Committee proposed to be constituted by the Canned Fruit (Sales Promotion) Bill 1959.
Question resolved in the affirmative.
Standing Orders suspended; resolution adopted.
That Mr. Adermann and Mr. Roberton do prepare and bring in a bill to carry out the foregoing resolution.
Bill presented by Mr. Adermann, and read a first time.
– I move -
That the bill be now read a second time.
The purpose of this bill is to impose a levy on apricots, peaches and pears accepted by canneries as of canning quality or for use in the production of canned fruit. The moneys so collected will be used to finance a scheme to promote the sale of Australian canned fruits both overseas and in Australia.
The scheme has been sponsored by the Australian Canning Fruitgrowers Association, the central organization of growers of canning apricots, peaches and pears, which claims to represent about 90 per cent of the industry in numbers in the three main producing States of Victoria, South Australia and New South Wales and 95 per cent of the Australian production of these fruits used in canning. In addition the scheme enjoys the full support of both the central organization of fruit canners - the Australian Canners Association - and the Australian Canned Fruits Board, which is the statutory Commonwealth authority charged with achieving the orderly overseas marketing of Australian canned fruits.
The Government has been glad to respond to this commendable move on the part of the canning fruit-growing industry to help itself and the bills I am now presenting are purely for the purpose of giving legislative expression to the industry’s own scheme.
I shall make further reference to the scheme in my second-reading speech on the Canned Fruit Sales Promotion Bill 1959. I commend the bill to honorable members.
Debate (on motion by Mr. Allan Fraser) adjourned.
Motion (by Mr. Adermann) - by leave - agreed to -
That leave be given to bring in a bill for an act relating to the payment and collection of the charge imposed by the Canning-Fruit Charge Act 1959.
Bill presented, and read a first time.
– by leave - I move -
That the bill be now read a second time.
The purpose of this bill is to provide the machinery necessary for the collection of the charge imposed by the Canning - Fruit Charge Bill 1959. The provisions of the bill are in general accord with the wishes of the central industry organizations concerned.
As both this bill and the Canning - Fruit Charge Bill 1959 must be read in conjunction with the Canned Fruit (Sales Promotion) Bill 1959, I propose to refer in more detail to the promotion scheme with which they are concerned in my second-reading speech on the Canned Fruit Sales Promotion Bill. I commend the bill to honorable members.
Debate (on motion by Mr. Allan Fraser) adjourned.
Motion (by Mr. Adermann) - by leave - agreed to -
That leave be given to bring in a bill for an act relating to the promotion of the sale of canned fruit.
Bill presented, and read a first time.
– by leave - I move -
That the bill be now read a second time.
The main object of this bill is to establish the Australian Canned Fruit Sales Promotion Committee, and to vest it with authority to utilize funds, to be derived from a levy to be imposed on fruits supplied for canning, for the promotion of sales of canned apricots, peaches, pears and canned mixed fruits of those varieties overseas and in Australia.
For several years now the fruit canning industry has been experiencing the effects of increasingly strong competition from other suppliers in practically all our export markets, and when it is recalled that some 60 per cent of our annual pack of canned fruits is exported the significance of this becomes very real. The Government has been lending the strongest weight it can to the exploitation of overseas markets for canned fruit and is assisting the industry in its trade arrangements with other countries, through the Trade Commissioner Service and per medium of the overseas trade publicity organization, towards the financing of which the Government is a heavy subscriber. Canners, of course, are already pushing sales quite vigorously but competition is intensifying.
The general trend of canned fruit production has been a steadily increasing one, and the industry now finds itself in a position of some difficulty. The logical points to concentrate upon in order to meet the present situation are to endeavour to increase sales on the domestic market and to intensify sales promotion efforts on export markets. The Australian Canning Fruitgrowers Association, a body representative of the vast majority of growers of canning fruit, has applied itself to the problem, and growers have generally recognized that they themselves must assist canners in the task of maintaining and, if possible, increasing sales. Accordingly, the association, on behalf of growers, has requested the Government to introduce legislation to impose a levy on growers based on their deliveries of canning fruit to canneries. The proceeds of this levy are to be made available for the purpose of promoting the sale of canned fruit both in Australia and overseas, and the bill I am now presenting, as I have already mentioned, is to establish a committee to formulate and carry out the promotion activities.
The two other central industry organizations concerned, the Australian Canned Fruits Board and the Australian Canners Association, have endorsed the proposal of the Canning Fruitgrowers Association, and the Canners Association has indicated that canners as a whole are willing to operate the machinery necessary to collect the levies from growers. It is envisaged that an annual fund of some £50,000 will thus be made available to enlarge in a rational manner on promotion work already being undertaken.
The constitution of the Australian Canned Fruit Sales Promotion Committee, as provided for in the legislation, will ensure the balance of voting power to the representatives of the Australian Canning Fruitgrowers Association; and the Australian Canned Fruits Board, the Australian Canners Association and the Commonwealth Government will also be represented. In this way the operations of the committee will run in harmony with, and supplement to the best advantage, existing promotion activities.
It is commendable that producers of the primary product should recognize difficulties facing disposal of their product in a secondary form and should levy themselves to provide funds to assist in ensuring its disposal. At the request of the growers the Government has been pleased to introduce these bills to give legislative expression to their wishes.
Honorable members may have noticed that canned pineapple has not been included in the proposals, and this, I assure them, is at the wish of that section of the industry. The Committee of Direction of Fruit Marketing, a growers’ co-operative operating under Queensland legislation, is already conducting quite extensive promotion activities in respect of canned pineapples at home and in overseas markets.
I commend the bill to honorable members.
Debate (on motion by Mr. Pollard) adjourned.
Motion (by Mr. Adermann) - by leave - agreed to -
That leave be given to bring in a bill for an act to amend the Canned Fruits Export Control Act 1926-1956.
Bill presented, and read a first time.
– by leave - I move -
That the bill be now read a second time.
The purpose of this measure is to amend the Canned Fruits Export Control Act 1926-1956 to provide for the appointment to the Australian Canned Fruits Board of a representative of the growers of canning apricots, peaches and pears. As presently constituted, the board consists of one representative of co-operative canneries of apricots, peaches or pears, one representative of proprietary canneries of apricots, peaches or pears, one representative of canneries engaged in the production of canned pineapple or canned pineapple juice, and a representative of the Commonwealth Government. The bill gives effect to the proposal of the Australian Canning Fruitgrowers Association, the central organization of the growers of canning apricots, peaches and pears, the members of which are claimed to account for about 95 per cent, of the production of these fruits used in canning.
The passage of this legislation will give the fruit-growers a direct voice in the conduct of board affairs, as is the case with all similar Commonwealth marketing authorities. The Government regards it as important that there should be collaboration and co-operation between growers and canning interests at all levels in marketing matters, and this is made more imperative by the difficult marketing period the canned fruits industry is presently facing. It is most desirable that growers of canning fruit should have a first-hand appreciation of the policies and decisions of the Australian Canned Fruits Board in its efforts to ensure the disposal overseas of our surplus production of canned fruits at reasonable prices.
Some 60 per cent, of our annual pack of canned fruits is exported, and about 90 per cent, of exports is directed to the United Kingdom. It is in this market that our 1959 pack is being disposed of in the face of stiff competition from other suppliers, notably California and South Africa. The immediate future holds little promise of any easing of the competition, and our ability to hold our position on the United Kingdom and other markets will depend to an ever-increasing extent on quality, price and sales-promotion activity, and in the outcome of these endeavours the grower is concerned equally with the canner.
I am confident that growers, through their representative, can contribute to the deliberations of the board, providing a direct link between the board and this section of the industry.
I commend the bill to honorable members.
Debate (on motion by Mr. Pollard) adjourned.
Debate resumed (vide page 2545).
– It would be fairly safe to say that national health schemes have always been in the nature of stormy petrels for governments that have introduced them. It is very easy for Opposition members to criticize the national health scheme, not constructively and certainly not on factual premises, as did the honorable member for Barton (Mr. Reynolds), who preceded me in this debate. Let me remind the House that Labour’s scheme failed to appeal, due mainly to the compulsion on all participants which was inherent in the scheme. Like all attempts at nationalization, it was spurned by the Australian community. It was not until the right honorable member for Cowper (Sir Earle Page), after negotiations and a trial run, introduced his National Health Bill in 1953 that this country was given a workable scheme. The scheme has been quite effective over the past six years, although I agree that there are certain adjustments which must be made, due to changes that have taken place during that period. The measure now before the House tends to do just that. The main factor undoubtedly has been the rise in costs. The steep increase from about £7,000,000 in 1953 to an estimated £25,000,000 in the current year is, of course, one which must merit our consideration. The possibility of such an increase was accepted in 1953 and, in fact, the right honorable member for Cowper, in his second-reading speech on the National Health Bill (No. 2) of that year, made special reference to it. I shall quote his remarks from “ Hansard “, Volume 2, at page 160, where he said -
The most costly free service in the scheme is the pharmaceutical benefits service, which provides for the supply of free life-saving drugs, on a doctor’s prescription, to every resident of Australia.
He went on to say -
The provision of free drugs has proved the Achilles heel of other national health schemes. It must be carefully safeguarded in Australia; otherwise costs will bolt.
I shall quote the right honorable gentleman further in reference to what had happened in New Zealand. He himself quoted words of the Director-General of Health in New Zealand. He said -
The Director-General of Health in New Zealand, in his 1953 report, said that one of the main causes of this increase was irresponsibility because of complete freedom from cost to the patient.
Claims have been made by the honorable member for Eden-Monaro (Mr. Allan Fraser) that the main cause of these increased costs was the abuse of prescribing methods by uninhibited members of the medical profession. This, unfortunately, has occurred but, we hope, to a very limited degree and, as we are reminded, specific committees were set up under the 1953 legislation to control any such actions. Therefore, 1 must incline to the assumption that the complete freedom of cost to the patient has been the main cause of the increased costs, particularly with the limited number of drugs on the free list. This has meant that medical practitioners have been prone to give way to what, after all, is a human instinct, of prescribing a more costly drug on the free list to patients not so wealthy rather than have them pay for a drug less costly but which is not on the free list.
The honorable member for Eden-Monaro asserted also that this bill takes no steps whatever to correct or to control those members of the medical profession in what he terms abuses of prescribing. Those were his words. Surely, it should be patent to the House that the imposition of the 5s. fee and the removal of complete freedom of cost to the patient, as well as the extension of the list to cover practically the entire codex have, at one fell swoop, achieved just that purpose. Nobody imagines that the imposition of this fee, in itself, will result in any considerable saving to the taxpayer. The extension of the list of itself would, undoubtedly, off-set any financial gain. It could well be that under the new scheme, costs could rise from the estimated £25,000,000 in the current year to £35,000,000 or £40,000,000 per annum, but from that point onwards a certain stability should be achieved in the cost structure.
I would say that such a stability in the cost structure, for this purpose, is one which must be present to give an administrator of the department some degree of guidance in budgeting for the requirements of his department. We must assume, therefore, that the imposition of this 5s. fee is for the purposes I have enumerated - (a) to prevent these prescribing abuses and (b) to stabilize the costs of the whole scheme.
However, it is with the method of applying this fee that I find myself at variance with the measure. There is a discrimination inherent in the exemption of closed friendly society dispensaries from the obligation to collect the fee from its members on the ground that those members already contribute towards the cost. But to me that has no real foundation in fact. Let us examine the position of contributors to friendly societies for the purpose of insuring against pharmaceutical costs. Their contributions take the form of a medical fee and a dispensary fee. Many years ago people took out this type of insurance with friendly societies for medical benefits, but that cover was not ever anything like the national health scheme of 1953 nor the scheme to-day. Therefore, to my mind they are not suffering, in any way, any abrogation of their rights if they pay the 5s. fee. The dispensaries assess, at fixed periods, their costs of running, and they operate on just slight marginal profits so that all the benefits are passed on to their members.
The fact that these dispensaries will now have each of their prescriptions, which now cover a much wider range, discounted by the Government to the extent of 5s. will force these closed dispensaries to have a certain amount of economic regression They will look at the fact that they will have to make increased charges to their members to help them operate. It is true, perhaps, that their increased charges, whether made through some charge per prescription at the dispensary level or by increasing contributions at the friendly society level, will nevertheless be made. They may not amount to the full 5s. but they could be something of the order of 3s. 6d. or 3s.
If this occurs, these people will finally be paying the same as if they paid the 5s. at the time of obtaining the prescription, and the friendly societies could then reassess their fees to allow lower charges for funeral, sickness and other benefits which are inherent in friendly society insurance.
I consider that the Government has chosen a very unwieldy method in its endeavour to take the closed friendly society dispensaries out of this category. It intends to bring down regulations which will cover identification of members of the dispensary. These regulations will also police any trafficking. All manner of things are being brought in by means of unwieldy legislation whereas if all were put on the one common footing - pharmacists, open dispensaries and closed dispensaries alike - then the whole thing would settle down, there would be no discrimination and the issue would be clean-cut.
I am reminded that an amendment to do this would be quite simple and I hope that the Government will accept - and I recommend to it that it accept - a simple amendment such as has been circulated in the name of the honorable member for McMillan (Mr. Buchanan). It seeks to delete paragraph (b) of sub-section (2.) of proposed new section 92A which will remove the exemption from closed friendly societies. The House will realize that the only reason that the 1953 legislation has operated as smoothly as it has in the past six years is that it was launched in an atmosphere of co-operation and agreement; all parties concerned joined in an effort to achieve this. But I am afraid that it is courting disaster to attempt to launch this new phase of the scheme without the wholehearted support of the pharmacists. I am assured that pharmacists, particularly in Victoria, are not very happy with the legislation as it is now framed. It could lead to the transfer of quite a number of people, particularly those with more than the average number of prescriptions, to friendly societies. I trust that the Government will accept the amendment circulated by the honorable member for McMillan.
The Minister for Health (Dr. Donald Cameron) in his second-reading speech referred to negotiations with the Pharma ceutical Guild of Australia, which is ex parte to this bill, on the subjects of formula and costs. I am quite satisfied that the Minister and the guild will, between them, make an arrangement that will give satisfaction to both the chemists and the taxpayers. However, other matters raised by the guild do not appear to have been adequately dealt with. I refer to the guild’s request for an amendment of section 99 of the principal act, so that agreement will be reached with the guild before the Minister actually determines rates and conditions. Another matter of concern arises from clause 21 of the bill. This introduces a new section 104A, which requires pharmacists to furnish statements of stocks at any time specified by the Director-General. This requirement could give rise to abuses. Having regard to the additional range of drugs and medicinal preparations, it could impose undue hardships on pharmacists, if no limitation is placed on the frequency with which the Director-General could ask for such a stocktaking.
I regret that I have left little time to give credit to the other provisions of the bill, which so well deserve our praise. I refer to increased medical benefits, particularly those relating to major surgical operations, and to the inclusion of certain contributors to medical benefit organizations in the fund benefits as well as the Commonwealth benefits. These contributors are people over 65 years of age and people with preexisting ailments who formerly were compulsorily transferred to the special account and were denied fund benefits. The honorable member for Barton mentioned this, but he did not take into account that this measure tends to correct the faults of which he spoke. The other matter which deserves our praise is the removal of all the heartaches and suffering created by the definition of “ recognized hospital “. This is a real improvement, and I know that it has been strongly urged by many honorable members right from the inception of the original legislation. I am again reminded that the honorable member for Fawkner (Mr. Howson), in speaking to this measure last night, mentioned that a very slight sum - I think something like £250,000 per annum - was allowed for research. I agree with him wholeheartedly that some action should be taken to increase this amount.
In the broad, this national health scheme of ours is really wonderful. The saving to the country cannot be measured by the yardstick of financial costs. As has been previously mentioned, the improvement in the general health of the community and in the efficiency of our work force is worth while, but perhaps the greatest boon of all is the victory that we have had over tuberculosis. These are our landmarks, and we can be justly proud of them.
.- One incontrovertible fact emerges from the discussion of the bill, and that is that Australia’s socalled national health scheme is urgently in need of drastic amendment and widespread alteration. I join issue with those who claim that it is a national health scheme. It is nothing of the kind. A national health scheme, of course, embraces everybody in the nation, but, although many hundreds of thousands of people participate in this scheme - I am told by the honorable member for Barton (Mr. Reynolds) that the figure is 67 per cent. - one-third of the community is not yet in the scheme. That means that 33 per cent, of the population is precluded from receiving any government benefits, although these people as taxpayers contribute for them. That is essentially a basic fault in the scheme. This may be called a health scheme, but it is certainly not a national health scheme when only two-thirds of the people are able to enjoy benefits, not for which they pay completely but for part of which the taxpayers as a whole pay.
Anybody who has made the slightest examination of the scheme, free from party bias, must admit that it has many weaknesses. It had many weaknesses in 1953, and the subsequent trivial amendments have not in any way strengthened it. That being so, it is most unfortunate that on this occasion, when the Government has seen fit to make several fairly substantial alterations, it has not seized the opportunity to remedy the anomalies and the obvious faults. The alterations, which I shall discuss soon, are not far-reaching enough and, in some respects, the problems have only been trifled with. The Government has gone only a very short way towards developing the scope of benefits which, in the opinion of very many people, are totally inadequate. The health scheme as we know it - I refuse to call it a national scheme - depends for its success on public participation and is based on the principle of selfhelp. But it must be made sufficiently attractive to maintain public support, and we know that a section of the public has not seen fit to join the scheme. Unfortunately, the proportion of medical and hospital fees met by the scheme has been falling at a regular rate since 1953 because of the diminishing value of the £1. Instead of covering nearly 90 per cent, of the average medical fees, as was originally intended, it covers at best 60 per cent. The honorable member for Fawkner (Mr. Howson) last night said that the figure was 80 per cent. I corrected him by interjection and said that it was 90 per cent., but he replied that I was wrong. Later in the evening the honorable member for Werriwa (Mr. Whitlam) referred to a statement that had been made by the British Medical Association to the effect that in the early days the scheme covered 90 per cent, of the average medical fees. I thank the honorable member for Werriwa for proving that my interjection was correct.
This bill in some very small way seeks to stem the downward trend in the relative value of the health scheme benefits, but the suggested new rates by no means adequately make up all the leeway. In fact, the Government is only playing with the problem. There is a particular need for a review of payments in relation to surgical treatment. The bill makes a very feeble effort in that direction - those are the only words that I can use to describe it - because the present maximum payment for various kinds of surgery bears little relationship to the cost of an operation. By its very nature, illness requiring major surgery frequently involves prolonged heavy expenditure in addition to the cost of the operation. This casts a very heavy burden upon the average family. Recently I underwent a major operation. In my ward in the hospital were men receiving only very ordinary wages who were concerned as to how they were going to meet their obligations because they had to pay the total cost of their operations. The amount that they will receive from the hospital benefit societies under the present scheme will by no means recompense them, and the additional £30 for a major operation does not bring these payments within cooee of what an operation costs to-day. I have personal knowledge of that.
There is the greatest need for adequate insurance to meet the cost of major surgery, but the amounts that are payable under the present scheme, and the additional amounts that are contemplated under the proposal now before us, are both very low and rigidly limited. Many people have found to their dismay that the total cost of an operation is far in excess of what they will receive from the benefit societies. I hope that nobody in the community kids himself that the additional amount that he will receive when this bill becomes law will make it any easier for him to meet the cost of a major operation. I shall prove my statement in a moment.
I had brought to my notice recently the case of a man who earns £22 a week and who underwent an operation which cost him £221, which included hospital fees. Under the present scheme he receives £76 but. when this bill becomes law, he will receive only an additional £30, so that, in all, he will receive benefits amounting to £106 to meet an account for £221, There is a vast difference between the two amounts, and I should have thought that the Government, knowing the gross injustice that is being suffered by most people in the middle income group who are unfortunate enough to have to undergo a major operation, would have grasped the nettle and provided a worthwhile amount to assist a person to meet the cost of an operation. After all, £60 for a major surgical operation is mere chicken feed. A good number of major operations require the services of not one but two Collins-street surgeons, and £60 will hardly meet the cost of their spare time, let alone the cost of the operation itself. Of course, it is highly debatable whether, when the proposed £30 is added to the present benefit, the surgeons’ fees will remain unchanged. As the honorable member for Eden-Monaro (Mr. Allan Fraser) said last night, it is extremely likely that the surgeons’ fees will rise. But even if they remain unchanged, £60 is nowhere near enough when an operation costs in the vicinity of £140 or £150.
In 1953 we were told that the scheme would offset the crippling financial obligations that might be incurred by ill health. Even the new list of benefits does not go that far. I am very disappointed that the Minister did not do a first-class job and bring the benefits to somewhere within reasonable distance of the cost of major operations to-day, particularly those in which two Collins-street surgeons may be concerned.
The health scheme does not give a member of a benefit society any right of appeal against the amount that the society allows him. A man sends his claim to the society and the cheque that he receives may not measure up to the amount that he has worked out for himself according to the table that he received when he became a member of the society, but there is no authority to which he may appeal against what he considers to be the small payment that he has received. After all, a murderer has a right of appeal to a higher authority; a man who commits a grave assault upon another person has a right of appeal to a higher authority if he is convicted, but a participant in this scheme has to take what the hospital benefit society gives him without having the right of appeal to any higher authority. It is true that the Minister, in reply to a question that I directed to him some time ago, said that if he had the particulars of a case that he would look into it, but every person is not prepared to write to the Minister to have his case investigated. In the first place, with due deference to the Minister, a person may not know who the Minister is, and secondly, he may not go to the trouble of writing because he may feel that the Minister is so busy that he will not take any notice of his representations. This legislation should contain a clause which will give a person the right of appeal to some authority if he thinks that he has not been paid enough.
Another serious weakness in the scheme, of which hundreds of thousands of people have had experience, is the failure to recognize dental treatment as a medical service attracting the payment of benefits. After all, dental health is an important factor in the maintenance of general health, and for most people it is a costly item. For the life of me, I cannot understand why dental treatment is not included in the scheme. Why is not physiotherapy also included in the scheme? After all, physiotherapy frequently follows the direct instruction of a doctor when the doctor feels that he cannot do any more for the patient. I had that experience myself. I went to a doctor who treated me on two or three visits and then told me that in his opinion I would receive the best treatment from a physiotherapist. I went to a physiotherapist on about five occasions and I was cured completely. The treatment that I received from him was just as important - perhaps more important in this instance because it cured me - than the treatment I had received from the doctor. But I received no benefit to meet the cost of the physiotherapy treatment. If a person attends a doctor he receives 12s. towards meeting the doctor’s fee of 17s. 6d. The scheme shows a remarkable omission in relation to physiotherapy treatment, and the position should be rectified as early as possible.
Why must subscribers to a society wait such a long period to receive their payment? After all, a patient has to pay the hospital before he leaves. In fact, progress accounts are usually submitted to the patients each Friday or Monday while they are in hospital. Doctors and surgeons expect payment as soon as their accounts are submitted, but when the account is sent to the benefit society - I have in mind particularly the Hospital Benefits Association of Victoria, of which I have some knowledge - weeks elapse before the inadequate amount to which a member is entitled is sent to him. The delay did not affect me to any great extent because I was able to finance the lag out of mv salary, but I can name to this House any number of people in my electorate who are in financial difficulties because of the delay in receiving their society benefits. The man to whom I have referred who had to meet a bill of £221, had to borrow £100 to pay the account, but he will have to wait six, eight or ten weeks before he receives his money from the hospital benefits association. The whole thing is wrong. The matter has been brought to the notice of the Minister on numerous occasions but nothing has been done because members still have to wait an interminable period before they receive the payment from the societies. Something must be done to speed up these payments, because often people are placed in embarrassing circumstances when they have to borrow money to pay their medical fees.
Another reason for our objection to the bill is the peculiar treatment that has been meted out to the chemists. I cannot understand why they have been treated in such a cavalier fashion in this legislation. “ Cavalier “ is the only word that I think describes the position. In the first place, chemists are placed at a serious disadvantage when the relevant standing committee considers features of the health scheme that affect the chemists and the Government. The standing committee at the moment consists of two members from the Department of Health, two from the Treasury and four representing chemists The chairman of the committee, I understand, is the Director of Pharmaceutical Services of the Commonwealth. A man does not have to be a mental genius to appreciate what happens when the four government nominees clash with the four chemists. A casting vote has to be given by the chairman, who is a government servant. It would be an extraordinary occasion when he differed from the other government nominees. I understand that that has never yet happened. Surely in the interests of fair play and justice the chairman of that committee should be a man drawn from outside, a man of independent thought and outlook not tied in with the chemists or with the Commonwealth health service. Why should an apparently highly paid Commonwealth public servant be the arbiter in any dispute between the four persons on one side and the four persons on the other side in that standing committee?
For the life of me I cannot understand why this position is perpetuated. At the earliest possible opportunity the Government should remove this grave injustice which is being handed out to the members of the Pharmaceutical Guild of Australia. When, from time to time, the guild has made applications for increases in dispensing fees it has always been told that the scheme is already too costly. For example, it has made many approaches to the Department of Health for improved rates of payment - I shall deal later in a brief fashion with how the rates are fixed - and has consistently had its applications rejected on the ground that chemists are making excessive profits. That is very problematical indeed, because figures supplied to me by reputable chemists in my electorate, by no means members of the political party to which I give allegiance, provide an absolute contradiction to that claim.
It is safe to say that the average chemist to-day is getting a reasonably comfortable living. Most chemists are, of course, cooperating in the health scheme, and most of them would make not more than £3,000 a year according to the actuarial figures supplied to me, which I accept unreservedly, because I respect the men who gave them to me. That being so, I think that the chemists should not be penalized just because the scheme is too costly. I know why the scheme is too costly. The honorable member for Eden-Monaro told us last night why it is costly.
I shall give one example of how the cost of the scheme is inflated. Recently, I went to see a constituent of mine, and arrived at his home while the doctor was there. The doctor told him that he would have to write a prescription for some tablets for him. As the man’s wife was out, I offered to take the prescription to the chemist, pick up the tablets and pay for them. When I asked the chemist how much the tablets were to cost, he said to me, “You are lucky you do not have to pay for them. They cost £4 10s., but they come under the free medicine scheme.”
The doctor had prescribed 100 tablets for the patient. I took that bottle of tablets back to my constituent, and a few days later I called and asked him how he was getting on with the medicine. He told me that he had had to discontinue taking the tablets after he had taken only three, because they produced an allergy. So 97 of these tablets prescribed by the doctor at a cost of £4 10s. to the taxpayer were completely wasted. The doctor could easily have prescribed ten or twenty tablets at the start until he saw the patient’s reaction to them. In this way the taxpayer would be saved a considerable amount of money in cases where a particular type of medicine did not agree with the patient. Since then I have discovered that this is not an isolated case, and that doctors prescribe 50 or 100 tablets for patients, which are free under the scheme, without their having any cer tainty that the patient is able to take without any deleterious effect the tablets prescribed.
The honorable member for Eden-Monaro was correct in the explanation he gave last night of why the scheme is too costly. But the costliness of the scheme is no reason for expecting chemists to do dispensing on the cheap because somebody else is falling down on the job. A chemist normally charges 6s. for an ordinary prescription, but under the Commonwealth scheme he can charge only 3s. for dispensing a prescription for a pensioner.
– That is for a compound prescription.
– That is correct. I should like to know whether this 3s. less received by the chemist goes to help this enlarged scheme proposed by the Government. If so, why are the chemists not given an opportunity to have more representation on this at present lop-sided standing committee? They did not have a chance to put a reasonable case for themselves in regard to this payment for dispensing prescriptions under the pensioner medical scheme. They just have to accept the 3s., and there it is! On the other hand, the British Medical Association gets preferential treatment, and the Minister should explain at the earliest opportunity the mystery of why such unfair treament is meted out to the chemists.
Chemists do a lot of work other than dispensing prescriptions. Although they do this work under the national health scheme they get no recompense for doing it. Reputable chemists in my electorate, whose statements I accept unreservedly, have told me that the paper work that a chemist has to do under the scheme amounts to about five hours a month. It is quite probable that the further obligations which this bill will impose on chemists will increase the time that they will have to spend on paper work to six or seven hours a month, but they will still get no recompense from the Government for doing it. Not a brass farthing! It is hard to understand why the Government is treating the chemists in such a beggarly fashion.
In addition, the chemists have not received fair treatment in relation to other fees. For example, since 1947, there has been a ls. 6d. dispensing fee for tablets dispensed under the Government’s scheme, and despite substantial cost of living increases received by just about everybody else who provides services to the community, no increase in this fee has been given to the chemists. They get the same old rate although other costs, such as rail fares, tram fares, wages and the cost of materials and many other things have increased substantially.
I appeal to the Government to cease treating the chemists as outcasts and pariahs in regard to this scheme. The chemists play an integral and very important role in the scheme, but all the Government has done is antagonize them unnecessarily. The chemists claim that they were never properly consulted about the Government’s proposal to impose a prescription charge of 5s. They were not asked for their views. The Minister said in answer to a question that they were asked, but they claim they were not. I do not know who is right, but apparently the chemists did not receive the consideration to which they are justly entitled. This is a fact which ought to be greatly deplored.
There is another aspect of the difficulties of the work of chemists that I wish to mention. Patients often bring to the chemist, for filling, prescriptions which have been wrongly written in that they are not in accordance with the regulations governing the scheme. The wrong prescription must be rectified; but the chemist cannot keep a pensioner waiting while he has the prescription adjusted, so he fills the prescription and then sets about having it corrected. He has to do this because he cannot claim under the scheme until the correction has been made. So the chemist is up for the cost of telephone calls to the doctor and letters to the department, and for delay and everything else. Having the prescription corrected will cost him lOd. in postage alone. Why should the chemist have to meet these expenses because of a doctor’s error? Why should this also be heaped onto the back of the chemist? What have chemists done to incur all this injustice?
I think that at the earliest possible opportunity the Government should give an explanation of this peculiar treatment of chemists. In addition it should make out, if it can, a case explaining why chemists should be called upon to act as unpaid tax collectors for the Government in relation” to the proposed 5s. charge for prescriptions. Why should the chemists be singled out to collect this charge? After all, they are not to receive any commission on the amounts collected by them. In those circumstances, it is definitely unfair that they should be expected to do these things in an unpaid capacity. The Government has plenty of money, so why should it expect a body of men who have given very patriotic services to the community for many years, for a very nominal return, to work free for it. After all, the average income of £3,000 a year received by chemists is not high in view of the fact that these men have to go through a long course of study to enable them to earn that income. They are specialists, and it is not fair to ask them to work for the Government in an unpaid capacity.
I should like now to have something to say about the proposed charge of 5s. per prescription. This is distinctly a retrograde step. When the community is awaiting a positive step forward on the part of the Government in meeting its responsibility for the health of the individual, this shackle of 5s. per prescription is imposed on it.
In the past, the greatest contribution to the community’s health has been made by government at all levels by means of what are known as environmental health services. Pure water supplies, sanitation, drainage, supervised food production, street cleaning and a protected standard of living have played the major part in defeating the plagues and pestilence of the past. Care of the individual in Australia has been left largely outside the sphere of government concern. Collective responsibilities like the provision of pure water supplies and of the other services that I have mentioned have been, very rightly, the concern of governments, and these responsibilities have been very successfully discharged. But governments have not been so consistent when it comes to the care of the health of the individual in the community. This matter is left to the individual himself, except for this totally inadequate and misnamed health scheme.
The provision of free life-saving drugs was a step in the right direction, and we acclaimed the Government for it. This
Government now proposes to take a step backwards by introducing this scheme under which a 5s. charge for the dispensing of each prescription will be imposed. I want to deal at length with the Government’s relations with the chemists in respect of this proposal, because I think those relations show that this Government has played a very paradoxical role in its treatment of the chemists and of doctors. Section 99 of the National Health Act provides -
The Minister may, after consultation with the Federated Pharmaceutical Service Guild of Australia, determine the rates at which, and the conditions subject to which, payments shall be made in respect of the supply of pharmaceutical benefits.
In other words, the Minister has the right to determine the rates. He fixes them. The pharmaceutical guild has the right to make submissions, but the rates are fixed, ultimately, at the whim or caprice of the Minister.
When we look at the position of the British Medical Association in Australia, we see that it receives much more preferential treatment Section 32 of the act states -
The Minister may, on behalf of the Commonwealth, enter into an agreement with the Federal Council of the British Medical Association in Australia for and in respect of the provision by medical practitioners of medical services for pensioners and their dependants.
The doctors have the right to enter into an agreement. Naturally, any such agreement would be approved by both parties. But the Federated Pharmaceutical Service Guild is denied a similar right.
Originally, there was a document setting out the terms of agreement accepted by both the chemists and the Government. This included clauses which automatically varied, in accordance with changes in wages, rents and so on, the dispensing fee paid. After this agreement had been in operation for some time, the Department of Health refused to apply increases in these cost-of-living factors to the chemists’ charges, and, in September, 1953, a new agreement was made. Victorian private dispensing fees less 10 per cent, discount were adopted. This scale of charges remained unchanged until the guild sought increases in the compounding fees some time in 1957. However, the parties failed to reach agreement and the Minister, in
April, 1958, determined a flat rate of 3s., which came into operation on 1st July, 1958.
This places the chemists in an impossible position. Terms applicable to them can be determined without their agreement, whereas terms applicable to doctors are determined by agreement with the British Medical Association. When that body reaches amicable agreement with the Government, the terms of the agreement are drawn up and duly certified in the proper way. The chemists are denied a similar right. I understand that the Minister has been treating with the chemists for months in this matter, and I suggest that, at the earliest possible opportunity, he should reach friendly agreement with them in order that they shall no longer be an aggrieved section of the community. And aggrieved they certainly are to-day!
I do not often agree with the honorable member for Maribyrnong (Mr Stokes), but I agree with him now. He took umbrage, and I certainly take umbrage, at clause 21 of this bill, which provides for the insertion in the principal act of proposed section 104a. The proposed section provides that the Director-General of Health may require a chemist to take stock of his drugs and medicinal preparations within a time specified by the Director-General. This provision is too wide. A chemist could be requested very frequently to make lengthy and costly stock returns. As I have already pointed out, chemists are at present expected to spend five hours of their valuable time every month preparing and despatching returns to the Government, and proposed section 104a will increase the burden on them. After all, this provision is a blank cheque, as it were. It could make chemists liable to submit returns weekly, monthly, six-monthly or yearly. This is a matter on which the Minister should reach agreement with the Federated Pharmaceutical Service Guild. There should be an agreement specifying the intervals at which stock shall be taken. In the proposed section, no period is specified, and this will operate entirely against the interests of the chemists.
The Minister for Health said in his second-reading speech that the guild had some apprehensions about the bill - that it was concerned about unfair competition by the friendly society dispensaries and about the fee to be paid by the Government for the dispensing of prescriptions under the pharmaceutical benefits scheme. The Minister said that he had been engaged in discussions with representatives of both parties.
– Order! The honorable member’s time has expired.
.- Mr. Deputy Speaker, Government supporters never expect the Government to receive any bouquets from Labour for the introduction of new measures. I feel that the whole of the opposition to this bill is based on Labour’s nostalgic love for socialized medicine and its despair at having been unable to introduce a national health scheme similar to the schemes in the United Kingdom and New Zealand.
Nobody questions the sincerity of the honorable member for Batman (Mr. Bird), but much of his case against this Government’s national health scheme was based on isolated examples. He talked of the great disparity between the medical benefit that he received for recent medical treatment and the doctor’s fee. If a person goes to a fashionable surgeon, he must be prepared to pay more than the average fee. A government cannot base a health scheme on the charges made by fashionable surgeons and doctors.
– They all charge similar fees.
– Fashionable doctors do not charge the same as do those who are not so fashionable. One pays a great deal more for ari operation by a fashionable surgeon than ‘ for an operation by an ordinary highly trained and competent surgeon.
The question which is exercising the minds of members of democratic governments everywhere is: What is the cost of national health? The honorable member for Batman glibly talked about having been to a doctor for treatment and then to a physiotherapist, and said that he had to pay too much. I suppose that if everything were free half of us would spend much of our time imagining that we had a pain in the neck or the back and going to physiotherapists for treatment. If we did, the unfortunate taxpayer would have to pay the cost. To me, it seems that some one must introduce reason into any national health scheme. The right honorable member for Cowper (Sir Earle Page), fresh back from England and New Zealand, has told us that the critical problem is the prohibitive cost, because, in national health schemes, we deal with human frailties. When treatment is charged for, a person who feels a little ill will tend to wait for a time in order to see whether his condition becomes worse. If treatment is free, people who are not really ill will clutter up the doctors’ surgeries and those who are really ill will be unable to get treatment.
Our psychological outlook on these things is different from that of Labour. Labour believes in the direct use of personal force. It believes in forcing doctors and patients. If such ideas were given effect, the doctors would become social bureaucrats and the chemists would be nationalized. Labour believes in personal forces and in socialization. We, on the other hand, believe in impersonal forces. Let the individual insure himself and receive individual benefit. Labour would like everybody to become a cipher or a number. This attitude has probably been brought about by belief in browbeating. I do not know whether that is so, but the Labour attitude towards free medicine has no appeal to me. I would rather pay a little bit towards the cost of medical treatment.
On the question of criticism, I would support the last speaker, the honorable member for Batman, who said that there is too big a disparity between what the average patient gets and what he has to pay. The figure originally intended was 90 per cent. The honorable member for Fawkner (Mr. Howson) was wrong last night when he said that it was 80 per cent. On this ground, I have some sympathy with the honorable member for Batman but, with regard to a lot of his other points, I have no sympathy at all. Our national health scheme was introduced after the pitfalls of the schemes in New Zealand and the United Kingdom had been recognized. To my mind, those two schemes have been of great detriment to the nations concerned.
If you examine the casualty lists for prisoners of war of the various nationalities - American, Australian, Dutch and British - you will find that the Britishers with their cradle to the grave welfare state had the heaviest casualties. We are a young country living in an Asian world and if we bring up our young people with a character which refuses to accept responsibility, how long will we remain a nation? This is where it starts - in national health and in a man’s personal and family responsibilities.
I do not usually interject, but yesterday, when the honorable member for Port Adelaide (Mr. Thompson) was saying that 50 per cent, of British revenue was spent on the welfare state I interjected and said that it was dreadful. It is dreadful that 50 per cent, of the tremendous taxation of the people of the United Kingdom should be spent on the welfare state. To my mind, it will not do us any good if we adopt that principle.
The honorable member for Eden-Monaro (Mr. Allan Fraser) was very critical of doctors who over-prescribe. That is a weakness in the present scheme. It is a natural and human reaction of doctors to do the best they can for their patients. After all, when we go to a doctor or a lawyer, we expect him to do his best for us. The honorable member was quite critical of doctors but I am sure that he acts similarly every day of his life. Presumably some of his constituents who have been denied benefits to which they consider themvlsees entitled come to him and ask him to make representations for them. Likewise, many people who have been rejected by repatriation tribunals no doubt ask him to make representations on their behalf. What does he do? Does he not examine the facts and put up a strong case for them? Of course he does. It is probably quite true that some doctors over-prescribe, but that is the human reaction of a person who is working for his client. This bill is designed to prevent over-prescribing or to bring it within reasonable bounds. At the same time, it is designed to benefit the patients because, in many cases, these new drugs are not necessarily the best to prescribe. I am not a doctor but I understand that the necessity for the patient to pay 5s. will relieve doctors and, in time, improve prescribing.
The honorable member for Batman said that the Government was treating the chemists cavalierly. That is not so. The chemists are not collecting taxes for the Government; they are collecting their own fees. In many years, this must be to their advantage because they have bad debts. At least they will receive the Government’s contribution, even if they fail to collect the 5s. So they will not be out of pocket too much. The Labour method of solving this problem would be to nationalize chemists, who would then become Government employees. That method would destroy a most important factor in the health service - the family chemist. The chemist-patient relationship is preserved by this health scheme just as the doctor-patient relationship is preserved.
One point of negotiation which I feel the Minister understands is that, because the scheme is extending into wider fields of drugs, the chemist will have to be allowed a higher dispensing fee. It is in that respect that I think chemists have expressed concern at the proposed alteration of present methods. I agree that chemists should be given a better fee because they will not be able to make the same extra charges as they used to make in order to cover losses and bad debts. I believe that, in negotiating with the chemists’ guild the Government will be fair and reasonable. The danger of the chemists making too large a profit at the expense of the taxpayer is normally governed by the impersonal forces of the capitalist system. If a chemist is making a very large profit, what happens? More chemists come along and, in time, the position rights itself. The Government parties prefer impersonal forces to the personal force of the socialist.
One part of this new scheme exercises my mind to some degree. This concerns repeat prescriptions. There are people, rich and poor, who suffer, say, from diabetes. I understand that, under the new proposals, the doctor will give a prescription for one month and for two repeats. Each of those repeats and the original prescription will cost 5s. But in the whole period the patient may go only once to the doctor for the prescription. In respect of people in the lower income brackets there could be hardship. I think that only the passage of time will reveal whether this system will impose a burden on those who are least able to bear it.
I have been surprised to learn in this debate, of the number of mistakes that Labour Party speakers have made in understanding the bill. The honorable member for Barton (Mr. Reynolds) said most emphatically that when a person became 65 years of age he was transferred to a special fund and that when his benefits expired, he got nothing at all. That is not a fact. Such a person, when he is transferred to the special fund is entitled to exactly the same amount as he was entitled to before transfer. There is a further condition that £12 12s. a week shall be paid to those who are transferred to the special fund after their ordinary benefits expire.
Yesterday, the honorable member for Eden-Monaro, leading for the Opposition, made an error in the interpretation of this bill. Several times, in this debate, as in all debates dealing with social welfare, the Labour Party has dragged out tales of misery and woe. Apparently, every Labour constituency is peopled only by those who are poverty stricken and suffering the torments of the damned - a veritable Dante’s Inferno. I do not find that that is so in my constituency. I do find some cases of tragedy which must exist throughout our society. The other day, the case of a married couple was brought to my attention. The husband had been working for an employer who had not taken out worker’s compensation insurance. The man was seriously injured and could not be paid compensation. That is the kind of case for which there is no special provision. But if as Labour would have it, maximum benefits are paid the whole time, irrespective of a person’s situation, the impost on the national economy becomes so great that there is never sufficient money to provide for special cases.
In every society and every constituency there are these things. They are not as numerous as contended by the Opposition, but we all know of them. If you spend all your money on those who are not really in need, how can you possibly provide for the exceptional cases? I suggest to the Opposition that sometimes it is not a bad idea to think of everybody. We should not try to use all the available money but should keep some for a few special cases. We should try to be more reasonable and put the scheme on the basis of what it is possible for a government to contribute and then try to make provision for the special cases.
This is a continuing scheme. No scheme is perfect. The present legislation does great credit to the Minister for Health (Dr. Donald Cameron). He is rectifying several weaknesses in the scheme. Provision has been made for new hospitals and a wider range of drugs. These are improvements to the scheme. But in operating the scheme let us retain some personal responsibility and get away from the awful thought of nationalized medicine and the welfare state, which would ultimately destroy a nation. In our geographical situation we cannot afford to be destroyed in this way. I believe that with the gradual improvements that are being made to the scheme, we will find that our scheme is one of the world’s best.
.- I think most honorable members enjoy the contributions made to debates by the honorable member for Hume (Mr. Anderson) and his speech to-day has been no exception. He was at a loss to-day to reconcile his attitude with that of his confreres in the United Kingdom, from where, I understand, he came some time ago.
– That is not right. He came from South Africa.
– Was it South Africa? But I have no doubt that the honorable member for Hume would have considerable sympathy with the policies of the Conservative Government of Great Britain. I do not think that any member of the Australian Country Party would dispute that.
In view of the honorable member’s criticism of the national health scheme I was interested to read a report published in the British Medical Journal of 26th September, 1959. The journal published an extract from the national health policy of the Liberal Party of Great Britain, which reads -
The Liberal Party’s election manifesto states that . . Liberals want “ better financial control of the Service,” and better pay and prospects for administrative and catering staff.
The party is anxious to swell the cost of the service in this way. The report continues -
The Party supports, in the interests of national economy, the charges imposed in 1951 for spectacles, dentures, and prescriptions, but is against the extension, made in 1956, of the ls. charge to each item on a prescription. It voted against this, it is said, because it would bear heavily on old people, on the chronic sick, on patients with large families, and on those with a small fixed income.
I should imagine that the honorable member for Hume would be at a loss to know where he stands in the face of that declaration by the Liberals of Great Britain - people who may be said to have similar political beliefs to the honorable members who grace the Australian Country Party benches in this House. There is no question that the Minister for Health (Dr. Donald Cameron) has panicked as a consequence of the increase in costs associated with the national health scheme in Australia. That increase has been similar to increases that have occurred in most parts of the world. That is so in most countries where there is any government participation on a grand scale. It is the case in the United Kingdom just as it is in Australia. But there is no doubt that the Australian situation is contributed to very substantially by the inflationary situation that has been allowed to develop unchecked by this Government.
Our serious financial situation in regard to national health has been brought about by inflation and rising costs. The fact that our budget revenue increases substantially every year is often mentioned. I think that before the war it was almost unprecedented to have a budget in excess of £100,000,000, but to-day we have an estimated revenue of £1,391,000,000. In view of that increase in revenue I do not think it can be said that the cost of national health has increased unduly. It is a fair thing to say that the Government is concerned because the pharmaceutical benefits scheme in this country, which cost £7,600,000 in 1951-52, cost almost £21,000,000 in the last financial year. It is possible that the cost will rise to £24,000,000 or £25,000,000 this year. With regard to hospital benefits, the cost has risen from £7,200,000 in 1952-53 to £14,800,000 in 1958-59. That cost is a considerable drain on the national health scheme. The cost of medical benefits has increased in a similar way. I understand that in July, 1953, the cost of the medical benefits scheme was £4,200,000, but that cost rose to £7,800,000 in 1958-59.
The bill has three purposes. Its first purpose is to impose a charge of 5s. on all prescriptions dispensed under the pharmaceutical benefits scheme. This imposition will produce revenue amounting to about £5,000,000. It is generally understood that hitherto there was no charge for certain drugs. Many honorable members on this side of the House take the view that it would have been far better to provide less in the way of tax concessions if this additional £5,000,000 was needed to bolster the Government’s participation in national health activities. We feel that the tax concessions will be of little benefit to the under-privileged members of the community who can ill afford to pay this charge for prescriptions.
The second purpose of the bill is to change the arrangements under which special account benefits are paid to the aged and chronically ill. I think this is highly desirable. It meets with the concurrence of most honorable members. We are pleased to see a more liberal interpretation by the Government of what is a recognized hospital. In my electorate there is a hospital maintained by the State Government for aged and chronically ill people which has not been recognized under the national health scheme and I am pleased to know that that situation will be rectified under the new arrangement.
The third purpose of the bill is to increase payments in respect of 140 items out of 1 ,000 under the schedule of medical benefits. We are told that the benefits for some classes of surgery will be as high as £60. During the course of this debate many honorable members, including the honorable member for Batman (Mr. Bird), have indicated that the proposed scale of benefits - as high as £60 - will in no way meet the actual cost of operations. A great deal remains to be done in this direction. We have been told that the benefits in respect of certain major operations will be doubled, but we have received no assurance that doctors’ fees will not be increased substantially. The House is buzzing with rumours, reliably founded, that doctors are contemplating substantial increases in fees as a direct consequence of this measure.
The Opposition is not impressed with the Government’s idea of a health scheme.
We consider this to be an apology for a scheme. We do not think that it compares with the scheme that has operated in New Zealand for some twenty years and which has found favour in all sections of the New Zealand community, whether they vote Labour or Conservative. In the United Kingdom a comprehensive and allembracing national health scheme has been in operation for ten years, and all political parties are giving it great support. At the end of its ten years’ operation we find that not only the members of all political parties, but also members of the medical profession and distinguished medical men who visit that country, consider that the scheme is contributing in no small measure towards the raising of health standards throughout the United Kingdom.
We consider that the amendments proposed under this bill will be completely incapable of changing a scheme that is basically unsatisfactory. We consider the scheme to be inequitable and unreasonable, and we have no doubt that throughout the Australian community it is most unpopular.
The Minister, in his second-reading speech, showed some enthusiasm for this scheme that the Government has had in operation. He said -
It is, of course, a matter of great satisfaction to this Government that there has been such strong public support for the purely voluntary scheme which we initiated and fostered.
Those of us on this side of the House who have studied the bill cannot understand the Minister’s reference to a purely voluntary scheme. We cannot see anything voluntary or spontaneous about a situation in which people are forced by economic circumstances to fall in with the Government’s arrangements if they are to obtain any benefit at all. We do not think there has been strong public support, and, in fact, the figures indicate otherwise. A survey of the various funds has revealed that of 10,000,000 Australians only 2,700,000 are contributors to the various hospital and medical funds. This has been interpreted to mean - and I am in no position to argue with the interpreters - that 6,700,000 of the Australian people are covered as a result of 2,700,000 having contributed to the various schemes. This is because some, of course, have contributed for their families as well as for themselves. But there has been no substantial or dramatic growth in these figures. There was an increase last year of only a miserable 3 per cent, over the figure for the previous year.
We suggest that the situation can be likened to a shot-gun wedding. The position is simply that the people have not wanted this contributory scheme, any more than the Liberals in the United Kingdom wanted the contributory ls. arrangement. However, the Australian people have found it necessary to comply with the Government’s wishes for economic reasons. Most people resent the fact that they are required to belong to a private organization in order to obtain the benefit for which they have contributed by way of taxation.
There are some very important reasons why this scheme cannot be considered a national health scheme. First, a large number of people have chosen not to have a bar of the scheme at all, and are not covered by the various hospital and medical funds. Then there are those who have taken less than the maximum coverage.
– What are the figures?
– I have already given the House some figures in this regard. I have already indicated that there are only 6,700,000 people with any coverage at all. Of that number there would be a good proportion who have only the minimum coverage. Until a short time ago a single contributor could pay anything from 9d. to ls. 6d. a week to a medical benefits fund, while family contributors could pay between ls. 6d. and 3s. Hospital contributions for single contributors ranged between 3d. and 2s. a week, and for family contributors between 6d. and 4s. It is a fair assumption that if you pay only 6d. a week you will not get anything like the coverage that you would by paying 4s. a week. In other words, people pay to the extent that their incomes permit. No one can deny that this scheme involves a means test of the most pernicious variety. It fixes the amount of benefit according to one’s capacity to contribute.
Ironically enough, we find that over the years in which the Government has had this scheme in operation, even the person contributing the maximum amount has not been fully protected against all eventualities involving sickness and accidents. Although some of the so-called life-saving drugs have been made available to those suffering from certain ailments, it has been the experience of every family that for a great variety of what might be called ordinary household complaints no remedy has been available under the scheme. Whether you have paid the maximum amount or the minimum, you have never in any circumstances had full coverage and real social security of the kind available under the schemes operating in New Zealand and Great Britain. It ls fair to say, therefore, that our scheme is a mere shadow of those which honorable members of the Country Party and the Liberal Party tend to condemn at every opportunity. There are many families which incur chemists’ bills of £2 or £3 a week, even though they have been contributors to the various funds for many years. In these circumstances, no one can describe the scheme as a national health scheme.
The list of available drugs is now to be extended to cover the items in the British Pharmacopoea, and if this represents an improvement every one will be pleased about it. But the Government has also introduced the 5s. levy on prescriptions. It has done this without any mandate from the people, quite surreptitiously, in the first year after the election campaign. On whose authority has the Government done so?
– The back-room boys!
– Yes, the backroom boys, and there is no doubt that there is a strong reaction to this imposition throughout Australia. We no longer have a free medicine scheme, if we ever did have one. Do not forget that it is quite likely that this imposition is. only the thin end of the wedge. What might this Government do on some future occasion, in the year after an election? Is it not likely that, for precisely the same reasons as it has imposed this 5s. levy, the Government will increase it to 7s. 6d., 10s. of 15s.?
– And then reduce it just before the following election!
– That is so. That is the way this Government has worked.
As the honorable member for EdenMonaro says, it is possible that just before an election there will be some reduction in the amount of the levy. How can this Government justify the principle of a flatrate payment for these prescriptions, which amounts to a tax on all sections of the community? It is beyond all dispute that additional revenue is required for these purposes. We of the Opposition agree that this is so. But on what new principle - or lack of principle, if you like - has the decision been made to abandon the capacity-to-pay practice in raising government revenue for these purposes? What is the reason for discriminating between the national health scheme and other social services? After all, when we think of child endowment, age and invalid pensions, widows’ pensions, repatriation benefits, maternity allowances and all the other social services, we take the view that the community should contribute according to capacity to contribute. He who receives the largest amount of income should pay at the highest rate, the amount then being reduced according to a sliding scale. What is the reason for discrimination in respect of the national health scheme? Our approach to these matters hitherto has been to increase the contribution according to the increase in income, but here we have a significant departure, and the perpetuation of this novel principle - or absence of principle - will result in the rich being relieved of their obligations at the expense of the poor. The basic wage earner will contribute precisely the same amount as a company director receiving £10,000 a year.
Then we have the unsung and unheralded means test on the pensioner medical service. Pensioners who have a separate income of £2 or more, giving them a total income of £6 15s. a week, will be paying precisely as much as any member of this Parliament, all of whom are in far better circumstances. If the honorable member for Hume and those who sit opposite are happy about that state of affairs, we would like them to be vocal about it in the period preceding the next federal election. We have made our position quite clear despite the consequences of the wrath and venom of those who might dare to prejudice us as a result of our stand. We think that honorable members on the Government side have an obligation to do precisely the same thing.
People are to pay 5s. for each prescription. Where will this policy cease? Surely, if, in the Government’s view there is no place for discrimination in regard to charges for national health, the time may not be far distant when we can expect an onslaught on the very basis of taxation which this country has known and come to understand for so many years. And all this about a scheme which is most unsatisfactory, anyway!
What a frail, intangible shadow of the British health scheme is represented by this emaciated form, this skeleton of a scheme which is foisted on the Australian public! Can anybody be proud of it? Is there any reason to be proud of it? Let us look at some of its most apparent deficiencies. First of all, I direct attention to the lack of any dental coverage compared with that in the scheme to which I have referred. There is no dental coverage for school children. Apparently there is no plan in the mind of the Government to introduce or initiate a scheme of this type to ensure that all Australians will have protection in this matter, regardless of their situation.
History will repeat itself. The Australian Labour Party has to take office every decade or so and pioneer legislation based on humanitarian principles and in the long run governments of the present kind reluctantly acquiesce in it. Optical services are omitted from this scheme. Can honorable members who sit opposite be proud of that? The scheme is working in other countries where a person, if he has defective vision and needs spectacles or finds it necessary to have his eyes tested, can obtain these services free of cost. Does any honorable member opposite deny that? Let the next honorable member who speaks on the Government side say whether he agrees with that or not. We want to hear whether honorable members opposite think that these people should not be allowed to participate in a benefit of this kind. Children of the low income-earners should be able to get spectacles if their eyesight is defective. They need the assistance of spectacles to enable them to do their school work properly and to earn their living when they leave school. Let us hear from honorable members opposite what they think about this omission, because so far the Government has ignored people of these circumstances completely. It is to the eternal discredit of this Government that these services are excluded from the health scheme and it is high time that the position was looked at. Australia is dragging the chain in these matters.
There is a limit also to hospital benefits. Many people think that if they belong to a hospital benefits fund they are covered indefinitely in all circumstances. But the truth is that there is a limit of 84 days - twelve weeks in twelve months - and this is very poor treatment. Who is the person most affected by this limit? It is the person who has been out of employment for a long time; it is one who has been extremely sick; it is one whose liability on his home or his car is mounting to high and very disturbing levels. But what happens in these circumstances? The attitude of the Government and of the funds is, in effect, “ Our patience and tolerance are exhausted. We will give this unfortunate away. He is no longer going to be accommodated in our scheme.” Where is the moral principle in an attitude of that sort? Can the Minister sit smug and complacent in the face of this situation?
The benevolence of the Government runs out in these circumstances. The milk of human kindness turns sour. It is nothing to smile about. If honorable members who sit opposite would go around the hospitals, as I do Sunday after Sunday and meet these people, they would find how difficult are their circumstances, but no extra consideration is given them. Indeed, they are denied the consideration which is extended to those who are the most fortunate.
There are those also affected by the lack of adequate provision for confinement. The period of fourteen days is laid down for confinement. A woman who is required to stay in hospital for longer than fourteen days is often one whose husband has been involved in a great financial outlay. There are such. If any honorable member goes along to the local hospital and makes inquiries he will find that the period of confinement is limited to fourteen days. Maternity costs have risen greatly. This Government has certainly failed to meet its obligations with regard to the maternity allowance. This benefit has become smaller and smaller, proportionately to the basic wage, ever since this Government has been in office. There are good reasons why people who are confined for periods of longer than fourteen days should receive additional consideration.
There are those post-maternity cases also who, because of adverse circumstances, are admitted to Tresillian, Karitane and similar nursing homes. What is happening to them? They are not generally covered by this scheme, unless the child is sick. But if the mother is sick and it is essential for her to attend at one of these clinics for advice about feeding, training and matters of that kind, or if she is a neurosis case following the birth of her child, she, too, is excluded from benefit. What is the miserable, paltry reason for picking out people of this type for exclusion?
Of course, repatriation cases are excluded from benefits under this scheme. We are told that one-third of all the claims accepted by the Government are rejected by the funds for different reasons. That is a pretty shocking state of affairs!
As to those covered by insurance, the scheme provides that where a contributor or dependant shall be entitled to recourse against third party, whether at common law or by statute or by any insurance, benefits shall not be paid. What is the reason for that provision in a contributory scheme? Why should a person be excluded from its benefits if he has taken the trouble to insure? Is the Minister satisfied about that? Will he fail to answer this point and the other points I have mentioned?
Then there are those excluded from benefits where misconduct is involved on the part of a contributor or his dependants. Who determines misconduct? It is a moot point. I suppose the fund makes a decision but it is another feature of the scheme which is a source of great aggravation to most contributors.
Another ground which precludes benefits from being paid is alcoholism and drug addiction and their effects. Why should people addicted to alcohol and drugs be excluded from the benefits of this scheme? Has any one any idea at all? Why should the unfortunate who has become subject to alcohol or drugs, the man who really needs attention, be denied? He might be a doctor or a successful businessman, but he is excluded. A tuberculosis sufferer, after the date of his positive diagnosis, is also excluded from the scheme. This is not a national health scheme.
What about those who suffer from mental diseases and disorders? There are probably nearly as many beds in mental hospitals to-day as there are in ordinary hospitals, but people suffering from mental diseases or disorders are not covered by this Government’s health scheme in any way.
Then there are those in that great category who are excluded by reason of default or other technicalities. Some fail to keep up their payments and if they become unfinancial for two calendar months they are excluded. Their failure to pay may be due to sickness or unemployment and because of the Government’s failure to help them with sickness or unemployment allowances they are unable to keep up their contributions and so fall out. Another group consists of those who cannot obtain benefits because of an insufficient qualifying period of two months. If they become sick within that period they cannot claim any benefits. Because of these pin-pricking technicalities, many fall by the wayside here.
Then there are those who fail to transfer from the dependant category on their seventeenth birthday. They may be ordinary, healthy, wholesome Australians but because they have not been advised by a lawyer or reminded of the need to change over from the dependant category to the single category when they turn seventeen, they are excluded from fund benefits. I know of many people who have been prejudiced on this account. There are those also who do not transfer from the single rate to the family rate upon marriage. This can have very serious consequences in respect to obstetric benefits, because these are not payable to single rate contributors.
Members on the Government side seem to think that these are things to laugh about. If they are so laughable and unimportant why have these exclusion provisions in the scheme? Many people going through times of anxiety or sickness overlook or are not financially able to meet their obligations. This is an indication of how this scheme is not comprehensive as are the national health schemes of the United Kingdom and New Zealand.
It is recognized that the Commonwealth has very limited powers on national health. The powers that it has are derived from an amendment to section 51 of the Constitution, which unfortunately arrived only in 1946 as a consequence of a referendum on the Consttiution. This was a great year for medical health. It was the year when the British Labour Government first legislated on these matters and it was the year when the Commonwealth acquired some powers over these matters. Ironically, the word “ health “ does not appear in the Australian Constitution. I cannot find any reference to health in any of the 62 pages of the Constitution. The States have the responsibility to provide services in respect of hospitals, mental hygiene establishments, baby health centres and the like, but they depend on the Commonwealth to sustain them financially.
– They have their own taxing powers.
– You had better take a bit of a lesson before you get too involved in financial matters.
– Order! The honorable member will address the Chair. In any case, the honorable member’s time has expired.
– The honorable member for Hughes (Mr. L. R. Johnson) has hardly done credit to the name of his constituency. He has lashed himself into a passion of frustration because the Government’s health scheme has proved to be most successful, when compared with the efforts of his own party. He worked himself into a synthetic frenzy about all sorts of conditions of men who are not included in the scheme, and finally lost himself in complicated verbiage; he was not quite certain where he was going, or what the scheme was doing. The fact is that the Government and the Minister for Health (Dr. Donald Cameron) can congratulate themselves on having established what is acknowledged to be, if not the best, then one of the best health schemes or a health scheme second to none in the world. The right honorable member for Cowper (Sir Earle Page) introduced the scheme, and we should all pay a very great tribute to him.
I cannot help but be slightly amused to hear the honorable member for Hughes and other members of the Australian Labour Party say that we should adopt everything that has been done in the British scheme. They object very strongly to the prescription charge of 5s., but if they had taken the trouble either to listen to the right honorable member for Cowper last night, or to investigate the British scheme, they would have known that it was Mr. Bevan who instituted the charge of ls. for a bottle of medicine. In other words, the Labour Party in England tried to put a brake on the rising costs of the scheme by adopting methods similar to those now being adopted by this Government. The charge did not work in England, and I do not believe that it will work here. I am much amused, therefore, to find the Australian Labour Party criticizing this provision, but advocating that we should follow the British scheme, when it was the Labour Party in England that introduced the principle.
I am interested, and also faintly amused, to find that we are, apparently quite inadvertently, now proposing amendments to the pharmaceutical benefits scheme which I believe are totally unconstitutional because of an amendment moved by our Prime Minister (Mr. Menzies) when he was Leader of the Opposition. Placitum (xxiiA.) of section 51 of the Constitution states -
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), benefits to students and family allowances:
I know quite well that when that provision was included the intention was to ensure that there would be no civil conscription, whether of pharmaceutical benefits or medical benefits. However, the Minister made quite clear in his second-reading speech that this 5s. charge .is to be compulsory, because if a chemist does not make the charge, his licence will be taken away. The Minister said -
As a breach of a condition of approval makes a chemist liable to have his approval terminated the legislation gives full effect to the Pharmaceutical Guild’s expressed request that the charging of the fee should be mandatory on chemists.
It seems to me that this very definitely amounts to civil conscription. I am quite certain that the Government is doing this inadvertently. If we were in Opposition, I would say that the Government was taking a long step down the road to nationalization of the pharmaceutical industry by stealth and deception, but I am perfectly certain that the Government is not doing that, but is acting inadvertently. Because of this principle, I am not happy with the bill.
I approve of what is being done with the medical benefits, because the Government is extending them. I am very strongly in favour of, and congratulate the Minister on, the amendment which allows those suffering chronic illnesses to come now within the scope of full medical benefits. I know that the area of medical benefits is being very considerably extended and, therefore, I wholeheartedly agree with the Minister and congratulate him on what he is doing. But I must confess, as an old parliamentarian, that I would have liked this to be done a little more effectively and Parliament taken more into the confidence of the Minister on what will actually happen with regard to costs and fees. We have not been given any figures. I suppose that somebody will say that we can search them out in some records somewhere, but, when we are asked to deal with these amendments, I think that the figures should be in the Minister’s second-reading speech. We have not been given any information as to the results of the operations of medical benefit insurance companies. I understand that some of them have built very large reserves; others may not have done so. But in any case, very little attempt has been made to estimate accurately what the increased costs will be and what the effect on the insurance fees will be. As a sort of rough estimate, the increased rate of contribution might be 3d. or 6d. in certain cases. I suggest to the Minister that the House would have been considerably assisted if more details of the results of the operations of these medical benefit insurance companies had been included in his speech. He said -
Before the plan comes into operation on 1st January next, every contributor will be able to get exact information from his own organization regarding the cost of insuring for the new benefits.
I should think that 99.9 per cent, of contributors would not be sufficiently au fait with the situation to make a special visit to their organization to find out what the cost would be. I certainly hope, therefore, that the organizations will send this information to their contributors, despite the increase of Id. in postage. However, I do not want to spend much time discussing medical benefits. As I say, the Government is to be congratulated on what it has done. One result in Melbourne of the hospitals benefit scheme is that a large number of private hospitals have come into existence and there is now a surplus of beds in public hospitals. That is very good. When the honorable member for Hughes was throwing his criticisms around in a broad, open-handed way, he forgot to mention, for instance, that tuberculosis had been practically eradicated as a result of the action taken by the Government under the previous Minister for Health, the right honorable member for Cowper, and the present Minister for Health. He forgot to mention all sorts of benefits that have been derived from the scheme that the Government introduced and has very successfully operated.
I am not at all happy with the pharmaceutical benefits aspect of the matter. In the first place, I think that if it were tested it would be found to be unconstitutional. But leaving that aside for the moment, I do not think that the main purpose of the amendment will be achieved. Again, may I refer to the speech that was made by the right honorable member for Cowper who is far more experienced in these matters than any other honorable member in this chamber, and I am only sorry that there was such a thin House last night when he made his speech. Although he was not overseas on official business, he investigated the working of insurance and health schemes in other countries, and particularly in Great Britain. He said that he had had a long interview with the DirectorGeneral of Health in Great Britain, and he went on to say -
The Director-General told me that unfortunately that-
That is, the charge of ls. for every ingredient in every prescription - did not stop the rising bill either … I believe that the method we adopted of providing hospital benefits and medical benefits by voluntary insurance should be adopted in regard to medicine also. I believe that chemists throughout Australia should organize themselves, as the medical profession has organized itself under the medical benefits scheme.
I agree entirely with the right honorable member for Cowper and with the honorable member for Paterson (Mr. Fairhall), who supported him. I believe such a proposal to be the only solution of the problem which has arisen with respect to free medicine. I direct the attention of honorable members to the fact that the charge of 5s. is for one unit in a prescription. The prescription may be for pills, a lotion or a medicine which contains other drugs. Thus, there may be three items in the one prescription which will attract a charge of 5s. each so that the patient will have to pay 15s. for one prescription. Why should this 5s. charge alter the existing position in any way? A doctor may feel that his patient would probably need only drug A to cure him, but because the patient will not have to pay for it, he may prescribe drug B which is much more expensive and will perhaps work more quickly than drug A. What difference will it make if the 5s. relates to drug A or drug B? In cases where expensive drugs are prescribed indiscriminately, the 5s. fee will not make any difference to the rise in the cost of the scheme.
Furthermore, it will not be easy for the chemists to collect their money, particularly chemists in country areas. In passing, might I ask the Minister to encourage his officers who are responsible for administering these schemes to exercise a rather more sensible outlook than they have in the past. I know of a case in which they returned to a chemist a prescription which had been dated by the chemist and by the patient at the time when it was made up and when the medicine was handed over, but which had not been dated by the doctor when he made it out. Apparently he had forgotten to put the date on it. The prescription went through all the channels from the chemist to the department, and then went through the same channels in reverse to the chemist with the request that he have the doctor date it. That sort of thing does not engender confidence in any scheme. I know that such a practice is not general, but I should like the Minister to inform certain people, who apparently do not understand very much about administration, that they should try to avoid such stupid actions in the future.
Friendly societies, particularly those in Victoria and South Australia, have been operating dispensaries in competition with members of the Pharmaceutical Guild. If there is to be a prescription fee of 5s., why should the present arrangement between the friendly societies and the guild be disturbed? Why should there be any distinction? If a friendly society finds that it has to pay the 5s., it can increase its subscriptions to cover it, but why make a distinction between one set of pharmacies, or dispensaries, and another, whether the proposal is unconstitutional or not? It is no good saying that there is a difference between the closed shops and the open shops. I know the Victorian friendly societies act, and the closed shop can become an open shop quite easily. Already in one district in Victoria one man is accepting new members on a subscription of 6d. a month, or some such infinitesimal sum.
– Is not the dispensary member taking up a voluntary insurance?
– If you are to have all voluntary insurance, all right, but if you say that there shall be a compulsory fee for every prescription, why differentiate? I am not against friendly societies; I am all in favour of them. It is wrong in principle to make something compulsory on one person and not on another. To date, the friendly societies have not been carrying the 5s. fee. They have fixed a fee for their voluntary insurance which excludes the 5s. Therefore, why not make the scheme allembracing, if it is to be compulsory, and say to them, “You must adjust your fees on the voluntary insurance, but must charge the 5s.”.
– Then for what services will the members pay the voluntary insurance fee?
Sit WILFRID KENT HUGHES.Friendly societies provide all kinds of insurances. I am not against them. I think that they have done a very good job. But why do we pick out A who sells a certain drug and say to him, “You must collect 5s. on that prescription “ and then say to B, who sells the same drug, “ You do not have to collect the 5s.”? If there were no distinction, the existing difficulties would be overcome.
I agree wholeheartedly with the right honorable member for Cowper. I should like to see the whole thing on the same basis as the medical benefits scheme, and then the people concerned would be more careful as to the number of drugs that they have in their cupboards because, if we have to pay for something, even if it is a small fraction of the total cost, we will be much more careful than we would be if we knew that somebody else would pay the total cost.
I am concerned also that no agreement has been reached with the Pharmaceutical Guild on the new rates of charging. I know that it has been said that the act will not be proclaimed until agreement has been reached, and that it is not anticipated that there will be any difficulty in reaching agreement. I have been in Parliament for 32 years and I know that anybody who accepts such a statement in all good faith is on very shaky ground. I have no reason to doubt that the Minister has spoken in good faith, and I am not pointing the bone at him when I say that he may not be the Minister to-morrow. Governments come and go while agreements of this kind are being consummated. It is highly dangerous to pass a bill and then say that it will not be proclaimed until a certain agreement has been reached.
We on this side of the House talk about our opposition to nationalization. I know that the guild has asked for an independent arbitrator on the advisory council. But whether there is an independent arbitrator or not. I understand that the Minister makes the final decision as to prices. When a government imposes a compulsory charge and whan a Minister makes the final decision with regard to prices, we are getting so close to nationalization that we will not have to take very many more steps along that road before we haw; a socialized pharmaceutical industry. For that reason, I am against the Government’s proposals on this matter.
I do not understand why, if the cost of expensive drugs falls in other countries as larger quantities are produced, that general pattern is not followed here. I ask the Minister to make some inquiries of the wholesale suppliers as to what is happening to make the pattern in Australia completely different from the pattern in other countries.
I do not want to speak at any length on this bill, but I feel, as I said earlier, that the right honorable member for Cowper and the honorable member for Paterson really put their finger on the weaknesses of this bill. I believe that they have suggested the only way to overcome the difficulties in which the Government finds itself in order to be fair to the patient, the taxpayer and the chemist. I approve wholeheartedly with the medical benefits provisions in their present form. But I do not like the proposed 5s. charge for prescriptions and I hope that this provision will be amended in committee. I hope more consideration will be given to the proposal, because it seems to me to be another case of the extension of bureaucratic control. I do not like making charges against people who cannot defend themselves in this House, so I will leave it to the Minister to have a look at this whole matter.
We are told what overseas countries did in an effort to prevent the costs of their health schemes from continuing to rise, and that the Government has decided to try the same method in Australia. The right honorable member for Cowper has proved to us that the method used overseas to keep down costs, which the Government is now to try in Australia, did not succeed in doing so. The Government now proposes to include 90 per cent, of the dispensing business under Government control as against 50 per cent, in the past, and it will not be long before the figure will be 100 per cent. This is another instance of how close we are getting to nationalization.
So I ask the Government to give the second half of the bill much more serious consideration than it apparently has had at present. I hope it will allow a full discussion on that part of the bill, in committee. Personally, I would rather have the provision postponed than amended, because I do not think that it will have any effect on Budget receipts. The Government may gain £5,000,000 as a result of this proposed 5s. charge for each unit of each prescription, but with the increase of the number of drugs on the list the cost of pharmaceutical benefits will rise well above the present cost of £20,000,000. It may rise by another £10,000,000, but let me be conservative and say that it will rise by £5,000,000. So the proposal will not benefit the Government on the revenue side in the first year, because the receipts from the 5s. charge will be completely offset by the increased cost of the larger number of drugs.
.- I do not very often agree with the honorable member for Chisholm (Sir Wilfrid Kent Hughes) but I agree with him to-night on a number of points. One concerns the nationalization which he so greatly fears. I hope that nationalization is ultimately brought about, not only in respect of hospital and medical services, but also on the coal-fields and in the economy as a whole. I support also the criticism and condemnation of the bill by the honorable member for Chisholm.
The purposes of the bill are threefold. First is the proposal to increase medical benefits on approximately 140 items out of 1,000 covered by the scheme. The second is the widening of the definition of hospital treatment to provide for those paying special rates to hospital funds. The third is the gradual extension in the list of pharmaceutical benefits. I believe that the extension of the list of pharmaceutical benefits is the only commendable feature of the bill, and the only one on which we can agree with the Minister.
The proposal to charge 5s. for each prescription dispensed is typical of the policy of this Government over a period of years. Before I proceed with that point, however. I wish to make reference to the remarks of the honorable member for Chisholm about the eradication of tuberculosis. Surely to heavens the honorable member is not seriously claiming for the Government credit for the success of the attack on tuberculosis. The present Government merely happened to be in office at the time when medical science, through the discovery of new drugs and new methods, was able to overcome the scourge of tuberculosis to the great degree that has been achieved. That is something that medical science did for this country, and I hope the same advantage can be taken to other countries, particularly the under-privileged countries, so that tuberculosis can be eradicated there too.
I turn now to the increased medical benefits in respect of 140 items. The Minister said in his second-reading speech -
It is, of course, a matter of great satisfaction to this Government that there has been such strong public support for the purely voluntary scheme which we initiated and fostered. There is no doubt whatsoever that a contributory health benefits scheme on a voluntary basis is the one most appropriate to Australian needs and conditions and that the future of this scheme is now assured.
Let me make an addition to that statement, with the words - “ under a Liberal government but certainly not under a Labour government “. I add those words because we of the Labour Party are as much opposed to the scheme as the people opposite are in support of it.
Any honorable member opposite who wants to know how much the people of Australia support the Government’s socalled voluntary scheme only has to look at the receipts of the various hospital and medical benefits funds throughout the “ears. The figures for past years, before the Government’s scheme was introduced, for the New South Wales fund, which is possibly the largest hospital and medical benefits fund of all, will show how anxious the people of New South Wales were for this voluntary system. In 1933, the income of that fund was £33,757. and in 1949 it was £547,928. That figure shows how much the people were interested in a voluntary scheme, when it is compared with the last yearly figure of receipts for the fund which, as a result of the introduction of the Government’s allegedly voluntary scheme of medical and hospital insurance, was £4,515,117.
Why have the receipts of that particular fund grown to this great figure? The reason is that people cannot afford to stay out of the scheme because, as a result of the Government’s legislation, if they do not join these funds they will be deprived of the government contribution to their hospital costs, to which they are properly entitled because of the taxation they pay and have paid. So, they are under economic compulsion to join a fund.
As far as the voluntary nature of the Government’s scheme goes, it is all right for people who were born with a silver spoon in their mouths. It is a very different story for the ordinary people. Let honorable members opposite go out among the industrial workers of this country and they will find out how many of them want this purely voluntary system.
I can tell you, Mr. Speaker, from experience, that the reaction of the people in industry to-day towards this voluntary scheme is complete opposition. Many workers in industry refused to join benefits funds because of their opposition to the scheme, but, as I indicated before, they were finally forced by economic pressure to join. They could not afford to stay out of the scheme, because, if they had done so, they would have lost benefits to which they were really entitled, having paid for them in taxes. I say to honorable members opposite: Do not ever get the idea that the hospital and medical benefits scheme is accepted by the people. The people as a whole are opposed to it. They always were, and always will be, just as the Labour Party always was and always will be opposed to such schemes which the Government introduces.
Later in my speech I will give the House facts and figures which will clearly show how lopsided is the scheme introduced by the Government under the guise of a voluntary scheme. I believe that facts and figures can be produced to show that the nature of this scheme is in conformity with the Government’s policy of giving tax concessions to privileged people on high incomes.
Sitting suspended from 6 to 8 p.m.
- Mr. Speaker, I indicated earlier that this bill deals with the national health scheme under four headings. It will increase medical benefits, widen the definition of hospitals recognized under the hospitals special account scheme, greatly increase the list of pharmaceutical benefits, and impose a charge of 5s. for very prescription.
We in the Australian Labour Party view the national health scheme as a form of governmental assistance to which the people as a whole are justly entitled in order to ensure that the health of the nation is raised to the highest standard that is humanly possible. There is one way to bring this about. That is by a planned scheme in which every one participates. At the present time, we have a planned scheme of sorts. We believe that the Government should introduce a scheme in which all the people can participate on the basis of their need and not on the basis of their ability to pay.
I have taken the trouble to take out some figures relating to this matter. The report of the Commissioner of Taxation for 1957-58 indicates that deductions for medical expenses claimed by taxpayers totalled £80,368,745 in that year. This represents a claim against the Commonwealth Government. These figures are analysed and actual statistics are given in the report. People with a taxable income of £50,000 claimed an average of £93 for expenditure on medical treatment. Taxpayers with taxable incomes of £10,000 claimed an average of £71 in medical expenses; those with a taxable income of £5,000, £54; those with a taxable income of £2,000, £43; and those with a taxable income of £1,000, £27. Taxpayers with a taxable income of £500 could afford to spend the magnificent sum of £14 per annum on medical treatment. This is indicated by the amounts actually claimed in tax deductions.
I feel, Mr. Speaker, that in respect of any health scheme, figures like these must be closely examined and closely analysed to enable us to find out whether the people that have the most money are the ones that can afford these medical benefits - whether they are able to spend money on improving their health, whereas the people on the low incomes cannot afford necessary medical treatment. I have already indicated the position of the taxpayer with a taxable income of £500 a year. This, of course, is not the gross income, but only the amount on which tax is paid. This would be the level of taxable income of a tradesman with perhaps one or two children, and people in this category represent a very large percentage of the whole community. These statistics indicate, Mr. Speaker, that the large mass of the people 1p in the lower-income groups cannot afford i the medical treatment necessary to main- j tain proper health standards. That is why we say that a national health scheme should be non-contributory, rather than, like our present one, based on the payment of a set amount by all.
This brings me to the point at which I propose to discuss the cost of insuring with an organization in order to obtain medical and/ or hospital benefits. Contributions amount to approximately £8 per annum to each fund or scheme. What does this sum represent for people in various income groups? We know that it is allowed as a deduction in arriving at the taxable income. This means that the taxpayer with a taxable income of £50,000 a year receives what amounts to a rebate of £5 ls. 4d. The man with a taxable income of £5,000 a year receives a rebate of £4 8s. Then we come down once again to the large masses of the people in the tradesman and labouring group. The taxpayer with a taxable income of £500 a year receives the magnificent sum of £1 as a rebate in respect of his contributions. The net effect is that the man with a taxable income of £50,000 a year pays £2 18s. 8d. for £8 worth of medical insurance, whereas the man with a taxable income of £500 a year pays £7. Further, as I have already pointed out, the statistics of claims made for deductions for medical expenses indicate that the people in the higher-income groups are spending large amounts on their health and maintaining their well-being, whereas the people in the lower-income groups cannot afford medical treatment.
For these reasons, we say that this whole scheme should be reviewed. The present set-up should be abolished. Let us review the whole thing from scratch. We believe that the total deductions for medical expenses of £80,368,745, which are allowed by the Commissioner of Taxation, represent about £20,000,000 of revenue. Therefore, the Government would gain an additional £20,000,000 of revenue if the present scheme were abolished completely and these claims for deductions were no longer made.
On the Government’s own figures, the hospital benefits section of the health scheme costs £14,802,290 a year, and the medical benefits scheme costs £7,779,451. So we could have a completely noncontributory scheme which would cost the Government only an additional £1,000,000 or £2,000,000. However, that would be getting right away from the policy which this Government has been putting into effect during the last ten years by granting overall tax concessions such as the recent all-round reduction of 5 per cent., most of the benefit of which goes to the people in the high-income groups. In fact, 9 per cent, of the taxpayers will receive the benefit of something like 90 per cent, of the total tax reduction. If the Government were to introduce a non-contributory scheme, as I suggest, and abolish the contributory scheme, the whole thing could be financed out of taxation.
I want to give the House an analysis of some other figures which can be checked and which cannot be denied. What does the Government’s proposal to charge 5s. for each prescription represent in hard, cold cash in terms of taxation? In the final analysis, every 5s. fee paid for every prescription will be claimed as a deduction for income tax purposes. Let us have a look at the actual figures and see what they disclose. For every 5s. prescription fee paid, a person with a taxable income of £50,000 a year will receive what amounts to a tax rebate of 3s. 3d. so that the net cost of the prescription to him will be ls. 9d. A taxpayer with, a taxable income of £10,000 a year will receive a rebate of the same amount; so that the net cost to him also will be ls. 9d. A taxpayer with a taxable income of £5,000 a year will receive a rebate of such an amount as to make the net cost of the prescription to him 2s 3d. The net cost to a taxpayer with a taxable income of £1,000 will be 4s. Then we come to the bulk of the people - the masses. They will pay a net amount of 4s. 6d. for each prescription.
– It is a fraud.
– As the honorable member says, it is a fraud. This sort of thing is typical of the policy of this Government. Its whole idea is that all, irrespective of income, will pay the same amount for a prescription.
– They do not have to.
– The honorable member is not in the chair now. He should know better than to interject, and if he does not stop it, we shall get Mr. Speaker to put him out.
With the introduction of this overall charge of 5s. for every prescription, those that can least afford to pay will have to pay most. I ask the Minister to reconsider the imposition of this charge of 5s. on prescriptions. To forgo it will not break the Government but to impose it will have a very detrimental effect on those people who already can ill afford to go to a doctor to get a prescription. I have pointed out that a man on £10,000 a year who incurs medical expenses of £71, pays only £26 after making allowance for taxation rebate, whereas the man on £500 a year who has medical expenses of £14 receives a rebate of only about £2 8s. Yet the income of the man who receives the larger rebate is twenty times greater than that of the man who received only £2 8s.! When it comes to the purchase of the things that are so necessary for the well-being of a family, there is no comparison between the incomes of these two men; nor is there any comparison as far as their taxation rebates are concerned. It is on this point that I ask the Minister to reconsider this whole question of national health. Can we not get away from the principle of the man on £10,000 a year receiving a rebate of 3.3d. of the 5s. prescription charge while the fellow on £500 a year gets back only 6d. These points are important and should not be forgotten.
As I pointed out earlier, if the Government were to abolish the system of taxation deductions for medical expenses the money that it would save could be used to introduce a full non-contributory medical benefit scheme which would be a credit to the Government and of immeasurable advantage to the people as a whole. I am afraid that the Government is not prepared to do that because it does not believe in the equality of individuals. It believes in the class struggle. It believes that the wealthy should retain their wealth and that the poor should not be assisted.
I hope that the Minister will not permit a set of circumstances to develop in connexion with medical benefits similar to that which occurred some time ago. When the original scheme was introduced the Government provided that in respect of a doc tor’s visit it would pay 6s., the fund would pay 7s. 6d., and the individual himself would pay ls. 6d., making a total of 15s. At that time, doctors were charging 15s. for a surgery consultation and 17s. 6d. for a visit to a home. But it was not very long before the doctors increased their fees from 15s. to £1 for a surgery consultation and to 25s. if they visited a patient at home. In addition, they imposed all sorts of penalty rates for visits on public holidays, Saturdays or Sundays or at certain times of the night.
I ask the Minister to ensure that when surgical benefits are increased, doctors will not immediately put up their charges1 for operations so that although a single contributor pays an additional 3d. a week and a married contributor pays an additional 6d. a week, no advantage will be gained from those higher contributions. I ask the Minister to take this point into consideration when he is conferring with the medical profession.
As I said earlier, the people of Australia as a whole do not want a contributory system. They have always been opposed to these alleged voluntary funds which the Minister talks about so glibly. They were only introduced by this Government for the reasons that I outlined when I cited the figures in relation to taxation. It is in conformity with the policy of the Government that the fellow in the high income group shall pay the same for his medical benefits as the man in the lower income group. The Minister did not give any indication of what he is going to do with the various hospitals that are classified, at the present time, as special hospitals. Is he going to have a more sensible and original approach to this matter? I do not suggest that the Minister should include various rest homes and places of that type. But many public hospitals will not permit chronically ill people to remain in their wards whether public, private, or intermediate. Relatives are told, “ I am sorry but you will have to take your mother home. We cannot retain her in hospital any longer. She is incurable but she will last for a long time. We are certain that we cannot do any more for her.” The young people find that, because of the nature of the illness, they cannot do a great deal for the patient. I am not speaking of hypothetical cases. I have a copy of a letter which has been forwarded to the Minister. I will not embarrass the people concerned by referring to names. But all the 25 people mentioned in this letter are in a condition that would entitle them to be admitted to a public hospital. They are in need of medical and hospital treatment. It is no fault of their own that they are in their present condition. They are all bed-ridden. Yet the Minister refuses to extend hospital benefits to them because the hospital they are in does not comply with his definition of what a hospital should be. This does not hurt the hospital itself. It still gets its fees. The relatives have to find the money to keep the patients in this hospital. So the Government is not hurting the hospital. It is only hurting the relatives by withholding the hospital benefit. So I ask the Minister, when he reviews this question, to give serious consideration, not necessarily to this particular hospital, but to this type of hospital. Patients are placed in these hospitals so that they will be looked after in a fair and reasonable manner. In the hospital of 25 patients, to which I have referred, there are eleven nurses who give them skilled attention.
There are many other points upon which I should have liked to touch but, in view of the limited time that is left to the Opposition to discuss this bill, I shall terminate my remarks. In conclusion, I ask the Minister to abolish this contributory scheme and reintroduce Labour’s hospital scheme. Unfortunately, the British Medical Association, with the connivance of the Liberal Party, was able to frustrate the Labour Government and prevent it from introducing its free medical scheme. I ask the Minister to give everybody the right to free medical and hospital treatment and to abandon the principle that those who have should keep it and those who have not, should do without.
– Mr. Speaker, the introduction of the national health scheme by the Government, through the auspices of the right honorable member for Cowper (Sir Earle Page), who was then Minister for Health, was a tremendous advance in social legislation in this country. No matter what honorable members may feel about the scheme, it has been universally acclaimed as a practical and, I believe, advantageous step towards solving a national problem.
It is safe to assume that the honorable member for Newcastle (Mr. Jones), who has just resumed his seat, will introduce the class-war angle into any arguments that he presents in this House. I was interested in his comparison between the amount of tax paid by some members of the community and the benefits received under the scheme. He cited the case of somebody on an income of £50,000 a year. Well, I do not know many such people. I think there are very few of them about. However, it is a good story - from the honorable member’s point of view. But what he failed dismally to show to the House was that any health scheme must be supported by the taxpayer. What he failed to present was this very pertinent point, that the people paying large amounts in income tax are making a direct contribution to this scheme and whether they get some slight recompense out of the fact that the scheme is adjusted on a universal basis is, I think, completely beside the point.
– Why should they get a benefit from the scheme if they do riot need it?
– If the honorable member will be patient I will answer him. This bill is a further step towards adjusting the scheme to our national requirements and changing conditions. The bill falls naturally into three divisions. The first section deals with alterations in the scale of medical benefits and provides for increased Commonwealth and fund benefits to be paid for certain operations and certain costly medical treatment. I believe that every honorable member will approve that aspect of the bill. I believe, too, that honorable members on both sides of the House will approve the second portion of the bill, which adjusts certain anomalies in the eligibility of institutions to obtain Commonwealth and fund benefits for inmates of those institutions under the special account scheme introduced last year.
The third portion of the bill is, to my mind, the most contentious portion. That is the portion dealing with proposals for changes in the pharmaceutical benefits element of the scheme. This portion was designed to introduce two major changes, with which I propose to occupy my time to-night. The changes are, first, a widening of the general list of drugs obtainable free of charge to include the same comprehensive range of drugs as is at present included in the list of drugs available free under the pensioner medical scheme. Secondly, the bill introduces a charge of 5s. for drugs prescribed from this expanded general list. When the pharmaceutical benefits section of the act was first introduced it was restricted to a free list of relatively few - approximately 40 - so-called life-saving drugs. In the first year of operation the pharmaceutical benefits scheme involved an expenditure of £7,500,000. The list of drugs has grown as the result of the requirements of the medical profession and as a result of discovery of advanced drugs until it now embraces some 170 items on the ordinary free list, plus some 70 items that are free when prescribed for certain ailments. In other words, the list has grown from some 40 prescribed drugs to approximately 240. The anticipated expenditure this year on the pharmaceutical benefits scheme is £24,000,000 - an increase of approximately £9,000,000 in the last two years.
These figures provide serious food for thought and I believe they also present a problem with respect to anticipated further equivalent increases and their impact on revenue and on the taxpayer. I was very impressed by the remarks of my colleague, the honorable member for Paterson (Mr. Fairhall), last night. He touched on the nub of this problem as to how much the public will be prepared to pay for health benefits and for health schemes generally. He quoted freely from a well-known book that was produced in the United Kingdom in 1952 dealing with this very problem. The actual point of his argument was that when you get into the philosophical side of health benefits and when you approach them from a political point of view also, you cannot deny the vast expense involved. We must remember that the original plan embraced a limited list of what are called life-saving drugs.
The bill before the House involves a much wider scheme. It involves obviously much greater expenditure. It takes in the whole of what is recognized as a fairly general pharmacopoeia. Also I believe that in the face of pressures from the public generally that we should make available the best medical treatment and the best drugs, we must accept responsibility for a vastly increasing expenditure in those items.
The pensioner medical scheme embraces the generally accepted list of drugs necessary for the treatment of diseases but that list- did not apply to the original national health scheme and this bill proposes to amend the list of drugs that shall apply to the national health scheme. With the idea of introducing some restraint in the prescribing of expensive drugs, and also to assist to finance this vast expenditure, the Government conceived the idea of introducing the 5s. charge for prescriptions, with some exemptions for a limited number of repeat prescriptions. It is believed that this charge may restrain frivolous abuse of the scheme. The analogy has been taken of the ls. charge introduced in the United Kingdom, which is purported to have had an influence towards restraining expenditure. However, I think the remarks of the right honorable member for Cowper last night indicate that the charge for prescriptions in the United Kingdom has not had the effect on the expenditure of the scheme that we would hope for in this case.
At first sight, the introduction of the 5s. charge seemed fairly simple, but on closer examination it contains many possibilities of anomalies and its effect on the pharmacy profession is what really worries me. Under the system proposed, it will be the responsibility of individual chemists to collect the charge from the customer. Speaking now for chemists in our country areas - and I believe I have some responsibility towards them - I wish to say that I have been assured that a high percentage - as high as 30 per cent. - of their customers are not directly contacted. In other words, the chemists provide prescriptions under doctors’ instructions for customers whom they do not see and therefore this charge must be carried on credit. I personally cannot visualize men of the ethical standards of the pharmacy profession refusing to supply drugs from the new general list because the 5s. is not paid directly or at the time of ordering the prescription. In those cases the chemists must wait for payment. I am told that it is not uncommon at the present time for long delays to occur before the chemist receives a script, after the doctor has given instructions to the chemist by telephone, and that until the script is received the chemists are unable to make claims for drugs already supplied.
I hope it will be possible, as a result of the discussions that are now proceeding, to make generous provision for this kind of contingency, so that the members of the pharmacy profession will be adequately covered and will not be out of pocket on such transactions. It does appear at the moment that some of the costs of the scheme must eventually be borne by these 4,000 chemists, who cannot in any way be held responsible for the huge increase in expenditure on the free medicine scheme. Furthermore, the virtual abolition of private dispensing, which the widening of the pharmacopoeia must involve, will remove one of the normally remunerative sections of a chemist’s practice.
It has been suggested that the 5s. charge for prescriptions will tend to check or restrain expensive prescribing. If there is any real substance in the allegation that there has been over-prescribing or unnecessary prescribing by members of the medical profession, then surely, with a wider availability of drugs and the knowledge that a charge of 5s. is to be imposed, a doctor with some consideration for his patient will decide on the slightly better or more expensive drug as against that which has a lower list price, because the cost to the patient will be the same in any case, if both drugs are on the general list.
I believe that members of the guild are quite justified in their claim that all dispensing of drugs within the list should attract the 5s. charge; in other words, that the charge should be levied on dispensaries and on doctors doing their own dispensing, as well as on chemists. The chemists have a strong claim that they should not be placed at a commercial disadvantage as compared with their competitors. If it is found that the proposed provisions react against chemists, then they must be altered.
I also believe that consideration should be given to the principle involved in section 99 of the act with regard to agreement on the scale of charges. While I realize that it is impractical for representatives of the guild to fix charges, I believe that their views should be given greater consideration by the standing committee. Chemists are responsible people who are providing a most valuable service to the community, and their part in the scheme involves them in a vast amount of paper work, most of which is very exacting. This office work has increased as the scope of the scheme has widened, and it seems certain that these new amendments will add further burdens of office work.
My attention has also been directed to clause 21 of the bill before us, dealing with the stocktaking required by the Director-General. It is considered by members of the profession that some form of qualification should be introduced to restrict this requirement, subject to agreement of the guild or committee of inquiry.
What the results of this legislation will be is difficult to forecast at present, but it does appear that there are strong reasons for a re-examination of that section of the bill relating to pharmaceutical benefits. The more I consider various methods of overcoming the rising costs, the more I am led to the belief that eventually we must evolve some contributory insurance scheme, such as has been suggested by the right honorable member for Cowper (Sir Earle Page), and has also been referred to by the honorable member for Chisholm (Sir Wilfrid Kent Hughes) and certain other honorable members. I believe this is a basic necessity in the future conduct of the pharmaceutical benefits section of the national health scheme.
Tn conclusion I would like to say that if this scheme is to progress, and if it is to remain within our economic capacity, there must be a great deal of restraint, both by the medical profession and by a section of the community which has hardly been mentioned. I refer to the manufacturers of the ethical proprietary lines of drugs which are now accepted as basic in the general pharmaceutical benefits scheme. I feel that there is an obligation on those two sections of the community to make sure that the scheme does not fall down under the weight of its own over-expenditure.
– This debate is of considerable importance to any one concerned with the health of the community, and any person who has listened to it and has studied the bill must be reminded of the policy that was followed by the Labour Government that preceded the present Government. We believed that free public hospital treatment was essential for the Australian community.
I believe that the speaker to whom we have just listened, the honorable member for Corangamite (Mr. Mackinnon), who said that we should first consider the taxpayer’s capacity to meet the financial requirements of the national health scheme, should certainly take his mind back and then ask himself why it is that we are not still providing free hospital treatment, at the public ward level, for those most in need of assistance. It is the family man, of course, the man who has not the wherewithal to consult specialists, who requires assistance to provide medical treatment tor his family. After all, if we are conscious of our moral responsibility to the Australian community, then we must consider first the family man. We must consider those who are bringing up the future generations of Australia. Therefore, in looking at this legislation, we should ask ourselves the very pertinent question: What does this bill propose to do for the man who is rendering the most valuable service in the community? What does it provide for the man who is rearing his family? What assistance does it give to those who are most likely to be affected by illness, suffered either by themselves or by members of their families?
Let me deal, first of all, with a particular matter in which the Minister for Health (Dr. Donald Cameron) appeared to take some pride. He said, referring to the negotiations preceding the drafting of this measure -
I am happy to inform the House that they have led to the formation of a plan under which medical benefits will be substantially increased for many surgical operations and other costly medical services.
This appears to be a kind of individual legislation, which does not take us very far in a real health programme. Perhaps we could call this corrective legislation. Let me direct the attention of honorable members to a document that was circulated by the Minister, headed, “ Proposed Amendments to Medical Benefit Schedules - 1959”, I refer particularly to page 11. Every person concerned with this kind of legislation must be impressed immediately with the kind of selection adopted by the Minister or his advisers in determining the small number and amount of increased benefits. I shall go no further than page 11 of this document, a perusal of which will show no less than twelve different surgical operations for which an amount of £11 5s. was provided under the old scheme as Commonwealth assistance. Is it not logical to assume that if, at some stage, the Government intended to adopt a basis of priority for legislation that would provide the maximum amount for serious operations, the same policy would be maintained? But that is not the case. Under the old schedule there were no fewer than twelve items listed at £11 5s., but in the new legislation these items have been divided .into three sections. The Minister said he was pleased that the Government had been able to do something like this, but he should have told us that in respect of these twelve only two are deemed to be so serious as to fall within the category of major operations and attract the higher fee. Some have gone from £11 5s. to £15, some to £18, but only two to £22 10s.
Last night, I heard an interjection to the effect that the Government was indulging in a confidence trick. If the Minister is pleased with this type of legislation dealing with such an important problem, he has every right to have all the happiness he can get out of it, if he can get any at all.
I leave that side of it by repeating what I said at the commencement: Would it not have been much better to devote these extra amounts that the Government now feels disposed to spend in this direction to free hospital treatment for the family man and the person who needs help most? But every action that this Government takes, day after day and week by week, points to the utter neglect of the man with the family or the person on the bottom rung of the ladder. Every step that it takes with regard to taxation or matters of this kind shows a neglect of the Government’s real moral responsibility to the family man in our community.
The same principle applies to the fee of 5s. for every prescription. When the Minister speaks of imposing something of this nature, he is not clear. When legislation of this sort comes before the House, members are entitled to know just what is intended by it. Speaking of pharmaceutical benefits, the Minister said that it was intended to bring the new list somewhat into line with the list that is already provided for pensioners. He said -
In any scheme conducted by any government there would necessarily have to be some limitation of the range of drugs falling within it
When this Parliament is called upon to agree to legislation of this kind members are entitled to have clearer details for their information than the Minister has provided on this occasion. We are entitled to know just what the Minister intends by this amendment. We should be informed of the list of items to which this 5s. fee is to be applied.
– Would you like all the drugs in the British Pharmacopoeia included in it?
– I will not be distracted by interjections of that kind. When the Minister is not prepared to say more than he has said in his second-reading speech, which shows that the Government cannot supply the lot, how can a backbencher try to tell us what the Government can supply? The Minister does not know what the Government can supply. He is dependent upon some “ hush hush “ committee to tell him from day to day what drugs will be on the list and what will not be. The list is subject to alteration all the time. It is controlled by a committee which has no responsibility to this House whatsoever. In replying to every question that is asked in this House on the issue of health, the Minister uses this committee as his first line of defence. The Minister has said -
In any scheme conducted by any government there would necessarily have to be some limitation of the range of drugs falling within it.
He should give a clear explanation as to just how far this 5s. fee for each prescription will apply.
It is not sufficient to say that the new list will be the same as that covering pensioners at the present time. On about five different occasions I have asked the Minister questions about pensioners who are excluded from medical benefits because of the 1955 means test imposed by a miserable government. The Minister spent some time throwing bouquets at the right honorable member for Cowper (Sir Earle Page) and referring to the work that he did some years ago for the national health scheme. It was some years ago that the right honorable member for Cowper said that if people had to pay for something they would appreciate it all the more. I have yet to meet people who appreciate being sick because they have to pay heavy medical fees in order to get well.
When the Minister was talking about mental institutions he made the admission that mental health is one of the most important problems in our community at the present time. He went on to say that the Commonwealth Government had made £10,000,000 available to the States, not to use in whatever way they wished, but for buildings only. Not long ago a debate took place in this House on the great work that had been accomplished, not as a result of providing buildings, but by providing assistance to combat tuberculosis. As a result, the scourge of tuberculosis in this country has been reduced by not less than 60 per cent.
Last night the right honorable member for Cowper dashed aside the question of mental hospitals and their upkeep; but he knows, as a medical man, that in doing so he is rendering a great disservice to a very needy section of people in this community. In New South Wales, as a result of the Labour Government’s legislation, mental hospitals are no longer known as mental institutions; but under the Commonwealth legislation the mentally ill are treated as though they never existed. They become forgotten persons. Their pensions cease, no matter what is their age. The Government does not pay them even a shilling to enable them to buy a small packet of cigarettes or anything to give them some enjoyment. The right honorable member threw aside the opportunity to say something about the medical needs of this great section in our community. Until the Government realizes its responsibility to those who are mentally afflicted and appreciates the fact that they are merely ill - the same as anybody who has tuberculosis or cancer or any other disease - it is neglecting a great section of the community and that is a standing disgrace to the Government.
In no other part of the world does a national parliament brush aside this question as this Parliament has done. In every other country governments are really trying to do something and with the assistance of new drugs many mentally afflicted persons have been cured over a period of years. Surely, when we come face to face with those who are trying to rehabilitate themselves, who have been restored to a measure of health by these new drugs, after having been confined to mental institutions for ten, fifteen or twenty years we should do something to help them. But this Government does not lift a finger to help these people by way of rehabilitation, sustenance or pension or in any other way!
The right honorable member for Cowper, when he talked as he did last night and pointed out that the Government had made £10,000,000 available for buildings, if they were wanted, and left it at that, brought no credit to his profession. I say to the present Minister that until a realistic approach is made to this problem, the needs of the mentally ill will be a standing blot on the community. I know that the Government which preceded the present regime did only something minor for the mentally ill, but at least it did start something and provided some small help towards approaching this problem. The need was not so acute then as it is now. I say to the Minister and to the right honorable member for Cowper that there is a moral obligation on those who control health in this country to assist, whatever the cost, to rehabilitate people who have recently been released from mental institutions as a result of cures effected by modern drugs. Surely, although the Minister has been in the Parliament for some years now, he has not lost touch with the moral responsibility that attaches to members of his profession and to the Government in relation to this problem. I say to the right honorable member for Cowper that, until he adopts an attitude towards this problem different from the attitude he adopted last night, he is rendering a disservice to his profession and to the Parliament.
Now let me return to the expenditure that is involved in this legislation. The Minister said that it would possibly reach £30,000,000 unless something was done. The Minister is a very honorable member of a profession that has an organization which is more powerful than any trade union in Australia. He is a member of the British Medical Association. If that association directed its members, as I believe it should, to avoid waste in the issue of prescriptions, the need to impose a charge of 5s. would never have arisen. I ask the Minister whether the imposition of this charge will correct the position. The imposition of a charge of 5s. will have no more effect than did the imposition of a charge of ls., or even 6s., which now applies in Great Britain.
– They know that, but they are after the £5,000,000.
– I am not so sure that that is so. I am not so sure that this is not just another attack on the man with a big family to keep, who needs a doctor more frequently than does the man who is better placed in society. I am not so sure that this Government is not becoming completely unattached from the great section of the community which should be given first priority if we really believe in “ Advance Australia Fair “. Every point that it makes is an attack on the family man. The income tax reduction of a flat 5 per cent, meant 3d. for the family man and a big whack for the chap on top, and, on a comparative basis, I include politicians in the latter class. But when it imposes a flat rate charge on prescriptions in this way, surely the cover is torn off and the Government is exposed for what it is. The Labour Party opposes this measure, and I am proud of its opposition. Step by step, this Government is marching towards a situation in which the men with family responsibilities will realize that they have in Canberra a government that is not at all concerned with family life.
This kind of legislation can have only one effect, in the long run. If the Government had cared to use the organizations that are available to it - the B.M.A. and the Pharmaceutical Guild - it would have found out quite conclusively, even from friendly societies alone, that the people who have most prescriptions are the people with the largest families. This type of legislation, which is singularly directed against families, should surely make Government supporters blush when they attempt to justify it. I agree with the honorable member for EdenMonaro (Mr. Allan Fraser), who is leading the fight on behalf of the Opposition. He said that we will fight this to the bitter end. We fight it not because of the charge of 5s. but because of the principle that is involved and because we know that this is a further attack on those Australians, with their families, who are least able to bear the burden of legislation that this Government consistently brings to the statute-book.
– Naturally, when the honorable gentleman from Eden-Monaro (Mr. Allan Fraser) speaks on the problems of social services, of national health or of repatriation benefits, I come into the House to listen to him. I do so for the very good reason that he is the best informed - perhaps the only informed - member of the Opposition on these problems. But on this occasion, it was of little or of no avail. I came, and I went away disappointed.
Now, Sir, let us cast our minds just a little bit back into the past. Any person who cares to do that will listen to what Opposition members say with perhaps complete scepticism or, giving them the “best of goodwill, with immense reservations. They will do that for the very good reason that Opposition members speak against a background of arrant failure by the Australian Labour Party to introduce a national health scheme. The Labour Party attempted to nationalize the medical profession and to take action which would destroy the integrity and the quality of the medical profession. And, thank God, it failed, and failed ignominiously.
Against that background of complete and utter failure, the public must listen with scepticism to Labour members criticizing the Government’s measures. The attitude of honorable members opposite to the problem of national health was perfectly defined by the Prime Minister (Mr. Menzies), in 1949, when he said that the Labour Party was attempting to purchase votes; that it was not interested in remedies or the prevention of disease, but was attempting to purchase the voting power of the public. The Labour Party failed in that attempt, and will continue to fail until it realizes that votes cannot be purchased but must be won by performance. By way of contrast, what do we find here? We find a scheme that is working now and working well. Over the years, it has been continually improved as the anomalies, one by one, have been removed and as we have made consistent attempts not only to increase the number of persons who may be covered but also to improve the quality of the services and of the drugs that can be provided. Consequently, we are entitled to claim that the Opposition’s arguments should be listened to with scepticism and with profound reservations.
May I turn to the proposals that were made by the honorable gentleman from Eden-Monaro. Even though we may have been a little impressed by what he said, I suppose that impression was completely ruined when we heard the contribution subsequently made by people like the honorable member for Werriwa (Mr. Whitlam) who, like the honorable member for Yarra (Mr. Cairns), will speak on every subject, whether he has heard about it before or not.
What my colleague, the Minister for Health (Dr. Donald Cameron) said is that in proposals relating to national health and pharmaceutical benefits, the Government must act responsibly. The Government must ask itself whether the community can pay for the increased benefits.
If it cannot, the scheme will be undermined and finally will be ruined. With this in mind, the Minister for Health said, “ Let us first of all accept a sense of financial responsibility and judge our actions against whether the proposals are financially responsible “. What was the first promise made by my friend from EdenMonaro? He urged that the Government restore the system of providing hospital treatment in public wards without charge. His second suggestion was that the Government provide salaried specialist services without charge. I think that the honorable gentleman should know that if there is one way to lose an election it is to try to buy votes by creating the illusion that you can do something now which, in the long run, is doomed to failure. The Australian public is far too wise to fall for that trick on a third or even a fourth occasion.
Let me return to what the honorable gentleman has promised and analyse it. I do not think for one moment that he meant what he said when he urged the Government to restore the system of providing hospital treatment in public wards without charge or the application of a means test. He could not have meant that because the total cost would be £75,000,000 per annum against a background of a budget deficiency of £61,000,000. Added together those two amounts would impose an intolerable burden on the Australian taxpayer and, far from providing a better health scheme, would have imposed such a strain on the people that the prospects of success would have been considerably reduced.
The honorable gentleman could have meant that he wanted to see the Chifley scheme introduced whereby the amount paid to a hospital by a patient would be contributed by the Commonwealth Government. On an average cost of 36s. per day throughout Australia, the Government, on that basis, would have been faced with an expenditure of £27,000,000 per annum. At the present time, the expenditure of such an amount would have imposed a heavy burden upon the Australian taxpayer.
The second promise by the honorable gentleman related to the provision of free specialist treatment. I do not want to go into an analysis of the figures at present, but I can say that on the figures that we could extract in respect of operations, pathology and radiology, a large proportion of which would be carried out in public hospitals, the cost would be of the order of £14,700,000. That does not take into consideration the free services that are given by specialists. We are, therefore, entitled to deduce that if a free service were instituted the cost would be far in excess of £15,000,000. If you add the £27,000,000 and the £15,000,000 to which I have referred, you will realize, Sir, that the Opposition has not chosen to think of the consequences and whether, in fact, the scheme could be financed by the Commonwealth. At the present moment, I do not think that it could be.
There is a second point with which I wish to deal before I touch on the substance of the bill itself. The honorable gentleman stated that any increase of benefits was generally swallowed in increased medical fees; and that the only beneficiaries of the scheme were the doctors. Frankly, I am appalled by that statement. I think that the medical profession in Australia has set standards that can well be approved by this House and by the Australian public. The profession comprises men who, on the average, are dedicated to the welfare of the community. It may be true that not all of them have such feelings of dedication because in any profession or in any walk of life there are some who deviate from the proper standards. However, far from being criticized, the profession should be complimented on the part that it is playing. The honorable gentleman made his statement without attempting to prove it.
Let us see whether it is the medical profession or the patients and the Australian community generally which is receiving the benefits of this scheme. What is the actual position? In fact, there has been scarcely any appreciable increase in the amount of Commonwealth benefit since the commencement of the scheme in 1933. The bill leaves the payment for general practitioner services which, after all, represent 75 per cent, of the total payments, unchanged at 6s., as it was in 1953. So the medical profession is not getting any increase on account of general practitioner services. Let us take the argument a little further. I think that it is wise to do so because the honorable gentleman has made a statement which cannot be substantiated. We sat here and listened to the emotional way in which be spoke. He gave the impression that his feelings were outrased, but he had not. bothered to ascertain the facts on this and about one other statement. He should not in fact have put the arguments to the House.
Let us look at the average cost of medical services. In 1954 it was £1 8s. 6d., in 1955 it was £1 9s. Id., in 1956 it remained at £1 9s. Id., in 1957 it was £1 lis., in 1958 it was £1 12s. 5d. and last financial year it was £1 12s. 9d. So, from 1953 to 1959 the average cost increased from £1 8s. 6d. to £1 12s. 9d. On those grounds, and taking into consideration the fact that costs have increased, can any one claim that the medical profession has, to use a rather dreadful expression that I hesitate to use, “ copped the lot “? On the contrary, we on this side of the House think that the profession has acted correctly and that its charges have been kept reasonable.
What has been the reason for the increase in the cost of this scheme from £4,500,000 to £23,000,000? The reasons are first, that the number of medical services received by patients has increased from 3,200,000 to 16,800,000, and secondly, that the number of persons covered by the scheme has increased from 3,500,000 to 6,700,000. We find, therefore, that the Opposition has criticized this measure, and the medical profession, without first adequately examining the facts and without knowing what the consequences of its arguments might be. The facts that I have stated are a complete refutation of the case that has been put by the honorable member for Eden-Monaro.
The only other point on which I should like to offer some explanation is the statement that was made by the honorable gentleman that the Commonwealth Department of Health has written to the State governments or to the hospitals stating that the 5s. fee for pharmaceutical benefits must be paid by patients in hospitals. The honorable gentleman is looking a little quizzical so I shall quote his statement accurately. He said to the Minister - !t is an official statement by your department. The Commonwealth Department of Health has informed the various State Governments that it requires the payment of 5s. on each prescription dispensed in hospitals.
– T checked on that to-day with the New South Wales Minister for Health, and it is correct.
– If the honorable gentleman checked it, he did not check it efficiently and his information was worse than it was last night. As my colleague, the Minister for Health, interjected last night, “That is a pure flight of fancy”. The simple fact is that the Commonwealth does pay a certain sum to the States, that is, the amount of the benefit less 5s. What the State governments themselves choose to do about that 5s. is their own concern. The Commonwealth has not told the State governments that they must compel the patients themselves to pay the 5s.
– The patient must pay it or the State governments must pay it.
– Well, let the State governments pay it. That is not what you said before. I am glad to know that the honorable gentleman has abdicated his position. If the State governments, Sir, want to pay the 5s., that is their concern. Patients in public hospitals receiving pharmaceutical benefits will be treated on an identical basis with other people. The Commonwealth Government will make its contribution, less the 5s., which is set out in the various schedules. The statement made by the honorable gentleman from Eden-Monaro was not accurate. Not only was it not accurate, but there is no intention on the part of the Commonwealth Government to act in the way that he said.
Now, Sir, I come back to the principles that have guided the Government ever since the inception of the scheme. The Prime Minister did say, in 1949, that we wanted a voluntary scheme. We wanted a scheme in which the Commonwealth would make a contribution, in which the insurance funds would make a contribution, and in which the patient himself would also make some contribution. But we have not thought for one moment that the scheme was fixed once and for all. There has been a consistent policy of continuously removing anomalies to make the scheme better, as opportunity afforded itself. In other words, the Government’s approach to this problem has been that if it could be shown that anomalies existed they would be removed if it was both practical and within our financial capacity to do so. Secondly, we have looked to those people who were most in need of support and help, and consistently help has been given where it was considered of the greatest benefit. The philosophy, and the policy, of the Government is to give help where we think it is most needed.
In applying this policy of the greatest benefit to the Australian people my colleague last year introduced a measure to cover people who previously could not receive the benefit from insurance funds - that is, people who are chronically ill, or aged, or have pre-existing ailments. That, I venture to say, was one way in which we felt that the national health scheme could be improved, and I think most honorable gentlemen and most sensible people would agree that that was a worth-while and magnificent contribution. It is against that background that we have to consider the scheme before us to-night.
Now, what are the actual proposals before us? First, there is the question of again applying the principle of giving help where it is most needed, of making the scheme as effective as we, as a Government, can make it. Consequently, the Minister for Health has introduced into this House provisions which are designed to increase the amount of Commonwealth contribution paid in respect of 140 items in the schedules of medical benefits. The largest increases are for major operations. One example given by the Minister in his speech was of an increase of Commonwealth benefit from £11 5s. to £22 10s. in the case of one major operation. Add to that the contribution which will be made by the insurance funds, and in such a case the patient could hope for a total benefit of about £60. In other words, the gross amount the patient would receive in refund would be increased from £30 to £60.
Now, the Opposition did not have much to say about this, but at least it is deserving of emphasis here that what the Government is doing is to double, in many cases, the amount that the patient can receive from the fund and from the Government in respect of a major operation. As I have said, Sir, the bill provides for increases of benefit in some 140 items covered by the schedules, and the Government’s proposals are a real contribution to the sick and needy.
I do not want to touch, one by one, on the various matters that have been dealt with so effectively by the Minister. However, I wish to make some reference to the pharmaceutical benefits scheme - I should first deal with one of the criticisms made by the honorable member for Eden-Monaro. That honorable gentleman said that he did not think the Government had touched the chief defect of the scheme, which was the need to provide a deterrent to overprescribing by the medical profession. He said the charge of 5s. would not be an effectual deterrent. What the honorable gentleman forgot was that it was no use looking at this question of the payment of 5s. on its own. What had to be looked at was the total scheme and not merely that section of it which most suited the honorable gentleman’s arguments. Do we think that the 5s. charge will be a deterrent to overprescribing? First of all, I should point out that the reason why the honorable gentleman claimed there had been overprescribing was that the cost of providing pharmaceutical benefits had risen from £7,600,000 in 1951-52 to £21,000,000 in 1958-59 and could be considerably increased, with the possibility of a rise to £30,000,000 a year. As the Minister for Health well pointed out, if the figure rose to significantly in excess of £30,000,000 the pharmaceutical benefits section could dominate the national health scheme, and this had to be prevented. I am not, for the moment, so much interested in that aspect of the case as I am in the argument of the honorable member for Eden-Monaro that the Government’s proposal will do nothing to prevent over-prescribing by the medical profession.
The first thing we have to ask is: Is there any real evidence of over-prescribing? Did the honorable gentleman produce any? Did he mention one case of a doctor known to him who had been guilty of overprescribing, and tell us the facts? On the contrary, he made this vague and unsubstantiated accusation, dwelt on it for a time, and then left it at that. We, as a government, do not for one moment claim that there has not been over-prescribing in some cases. Of course, there has been! But no scheme can be devised which is incapable of being evaded in some respects. So, of course, we think, and expect, that there will be some evasion of the provisions of the act.
What has the Minister done to reduce over-prescribing to the minimum? In an attempt to prevent over-prescribing he has done something that I think will be of benefit to the scheme. He has widened the range of benefits that may be provided. Here I hope I am not taking too much of the arguments of my honorable friend from Maribyrnong who may follow me in this debate. He may wish to take the same line as I have been taking. In any event, what my colleague has done in an attempt to prevent over-prescribing is to widen the range of drugs that can be prescribed by the medical profession so that, instead of doctors having to prescribe the limited range of the more expensive life-saving drugs which are now free, they may prescribe the most effective drug available in the newer and wider range and in many cases at cheaper costs, in the knowledge that it does not matter which drug may be prescribed, the patient will have to pay only 5s. for it. It is not the 5s. charge which is important. The important fact is that the medical practitioner has a wide range of drugs from which to prescribe and each prescription will require a payment of 5s. from the patient. So there can be no real inducement or incentive to prescribe the more expensive drugs, or a drug for which the patient will not have to pay.
A fact that is just as important is that there is an investigation committee which constantly examines the accounts and prescriptions of doctors and, if it finds consistent evidence of over-prescription, it makes the medical practitioner himself explain why he has departed from normal methods of prescribing. If he cannot give a satisfactory answer he can be penalized under the provisions of the act. There are deterrents to over-prescribing. The Minister has attempted to impose additional deterrents, and personally we believe that at the moment the scheme is working well-nigh as effectively as human beings can make it work. Time alone will tell.
Now I turn to one other part of the case put by my colleague, the Minister. I do not want to exaggerate here, and I do not want it to be thought that I am complimenting the Minister on the job that has been done merely because I am a member of the same Government. I think an objective observer would agree that consistently over the years the Minister has made reasonable and practical efforts to complete this scheme and make it effective. I believe, with my colleague, the honorable member for Fawkner (Mr. Howson), that under present economic conditions and without a vast increase in expenditure now that these amendments are being made - in one case, removing an anomaly, and, in the other case, making improvements - there is nothing that I can suggest that would significantly improve the scheme. To that extent, I think that the community is indebted to my colleague, the Minister for Health.
There is one point that I should like to bring to the attention of yourself and the House, Sir. It is this: Three sets of people have to be considered when this bill is being discussed. The first is the medical profession itself. I think it is fair to say that if the medical profession benefits the patient also will benefit. My colleague and friend has pointed out that under the national health scheme, and particularly under the pharmaceutical benefits scheme, the medical profession will have a much wider range of drugs from which it may prescribe. It is sensible to deduce that, if the profession has that wider range of drugs, the patient will benefit by getting the best drugs available at the minimum cost. Consequently, I think that that part of the argument advanced by my colleague, the Minister, should be emphasized. First, the medical profession will benefit because doctors will be able to prescribe a wider range of drugs, and, secondly, the patient will benefit because he will receive the best drugs available. I have had to omit the second set of people - the chemists - because my time is drawing to a close.
Finally, Sir, as to the third group, I think it is right to point out that, when we are contemplating a national health scheme, we have to be certain that the scheme not only benefits the patients but also can be financed by the taxpayer. In other words, this Government must make certain that the burden that it imposes on the taxpayer is not intolerable. The taxpayer is the one who produces the goods, and it becomes axiomatic that if you impose too many deterrents and restrictions on him he will not do his job effectively, and produce the national income out of which the benefits are financed. The very foundations of the national health scheme would be undermined and, finally, would collapse.
I compliment the Minister on this bill and on the national health scheme. If there is one thing that the Menzies Government can be proud of, it is its efforts in the fields of social services, health and medical benefits, and repatriation. The national health scheme, Sir, is a monument to the efforts of this Government to achieve social justice.
I finish on this note, Mr. Deputy Speaker: The Opposition may be as critical as it likes. The honorable member for Werriwa always wants to damn schemes devised and brought into being by Australians, and he always praises and recommends what is done in other parts of the world.
He has never, so far as I know, praised the achievements of Australians. This Government’s national health scheme is a good one by any standards, Sir, and I commend it to the House. A series of elections has proved, too, that the Australian public is wholeheartedly behind the efforts of the Menzies Government to achieve social justice by such means as its health and social service legislation.
– I wish to make a personal explanation, Mr. Deputy Speaker. I have been misrepresented by the Minister for Labour and National Service, who has declared to be false the statement I made last night that the Commonwealth is now demanding that every hospital patient must pay the new tax in future, whatever his means and whatever ward he may be in. The Minister has declared that that statement is false, although he now admits that the Commonwealth is requiring such a payment. He says that I am in error because the payment can be made by the State government and need not be passed on by it to the patient. I wish to point out to you, Mr. Deputy Speaker, the misrepresentation by the Minister. What I actually said last night was this -
This means that unless State governments bear the cost themselves, a new charge will now have to be imposed, probably for the first time in hospital history, on patients in public wards, for drugs which have never previously been charged as extras in public wards.
I suggest, therefore, that the Minister has admitted completely the truth of what I had said.
.- Mr. Deputy Speaker, the Minister for Labour and National Service (Mr. McMahon) must surely be a reincarnation of that gentleman who Disraeli said was inebriated by the exuberance of his own verbosity. Surely, a number of honorable members on his own side of the chamber desire to contribute to the debate on this bill. I know that there are some on this side who desire to contribute to the discussion. The last half hour has been entirely wasted, Mr. Deputy Speaker. We have heard nothing new. We have heard nothing fresh, but merely a re-hast of what has gone before - a defence of the indefensible.
This Government lives in the past, Sir. If it can continue to deceive the electors for the next 100 years, it will, I am sure, still be defending itself in the year 2059 by pointing back to 1949, the year in which it managed to win office. We, on this side of the House, grow weary - and I have no doubt that the people, too, are growing very weary - of hearing these continual references to what was spent on pharmaceutical benefits, medical benefits, social services or something else in 1949. This Government has occupied the treasury bench for the whole of the ten years since 1949. It seems to ignore the fact that ten years have rolled by since it took office, and that vast changes have taken place in population and in the value of money. Its only defence on any matter is to hark back to 1949.
I think it is worth while to remind the House at this point, Mr. Deputy Speaker, that, in the powers referendum proposals of 1946, as a result of which the Commonwealth was given power to legislate for social services, including dental and medical services, Labour caused to be included a provision preventing the nationalizing or socializing of doctors. We have to listen for far too long to the smear and the gibe that Labour wants to socialize the medical profession. In this connexion, I want to refer to placitum (xxiiiA.) of section 51 of the Australian Constitution, under “ Part V. - Powers of the Parliament “. It appears at page 141 of the publication “ An Introduction to the Australian Federal Parliament”, which has been prepared under instructions from Senator the Honorable Sir Alister McMullin, President of the Senate. This placitum of the Constitution, which was inserted as a result of the powers referendum in 1 946, provides that the Commonwealth Parliament shall have power to make laws with respect 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), benefits to students and family allowances.
I think this ought to silence once and for all the cry that Labour has set out to nationalize the medical profession. Nothing could be further from the truth, and it is about time the Government stopped repeating that infamous lie.
I want to deal now, Mr. Deputy Speaker, with what I describe as the enforced role of the pharmacists in the national health scheme. May I just observe, on this point, that the Government appears to be outsocializing the socialists. It continually refers to us smearingly as the socialists. But I suggest that, if this measure were being perpetrated in Moscow, the harshness of the attitude adopted by the rulers of the Kremlin in imposing on the pharmacists of Russia a scheme such as this would be severely criticized. 1 want to make a further reference to the constitution of this advisory committee about which we have heard so much. This is the refuge behind which the Minister for Health retreats in order to defend the indefensible. It is a committee of nine. There are four representatives of the pharmaceutical profession, four Government nominees and a chairman nominated by the Government. It would seem to every reasonably minded person that the Government would be inclined to nominate members who would be sympathetic with its beliefs. In fact, that seems to be how it has worked out. So the dice is loaded very definitely against the pharmaceutical profession in the formation of this committee. In fact, if this committee were operating in the reign of the Stuart kings it would have been part of the work of the Star Chamber.
– That is going back a long way.
– I am going back a little further than 1949, but I will not dwell on that as the Government so often dwells on the 1949 period.
The cost of this scheme is to be found mainly in the cost of the drugs which are prescribed. I do not want to re-hash everything that has been said in this House on this subject but there is no attempt in the bill, as there should be, to place some curb on unnecessary prescribing by a minority of doctors. There is no doubt that once a doctor in a certain district sets out to prescribe all the most expensive drugs he can think of, the news gets around and he becomes regarded as a sort of local saviour or messiah, to the detriment of the other doctors. If they want to compete with him they have to follow suit. An attempt must be made to place some curb on this practice.
Why are some of our drugs so costly? One antibiotic which I was shown a few days ago in a pharmacy is sold under nine different names. Each one of the variously labelled and coloured bottles contains a different number of capsules and each bottle bears a different name. But the price is the same for the same number of capsules and that price is primarily dictated by the combine or monopoly of drug manufacturing houses. The chemist has no option but to give whatever the doctor prescribes. He knows, when he does so, that he could pick any one of the nine bottles and the patient would get the same result.
I think that an attempt should be made to examine the drug manufacturing industry because there can be little doubt that it is getting far too much profit. That is one of the reasons why the Government’s scheme has been so expensive and has been such a drain on the taxpayer. The Government has decided to do what it did in the postal charges legislation and get a few million pounds back from the ordinary people. It is taking similar action in the field of national health and getting a few million pounds back at the expense of people who cannot afford it.
I have no doubt that millions of pounds are spent by drug manufacturing houses on research into new and very valuable drugs. I do not quibble at their right to recoup themselves for their expenditure even on a fruitless search for a drug which might be of great benefit to mankind. But we are left with a feeling that they recoup themselves several times over. I do not think that any organization, in any field of manufacture, should be entitled to recoup its expenses several times over. In this field, it seems to me that an attempt could have been made by the Government to enlarge the scope of the Commonwealth laboratories. I see no attempt being made to do that. The Commonwealth laboratories have already done great work. They have produced the Salk vaccine, in respect of which they did a very good job.
But I feel that in the field of antibiotics, when we are being exploited by the drug houses, the Commonwealth laboratories could be safely entrusted with the task of breaking the combine.
There are two other matters to which I desire to refer. First, I wish to refer briefly to hospitals for the aged. I note that the scheme fails to make provision for the financing of what I call “ semi-hospitals “ - institutions which house and care for the old. The Government’s scheme, as revealed here, is vague and amorphous. At the moment many old people can receive their age pension and, with eight weeks’ advance membership in a hospitals contributions fund, a further £7 per week from the Government, making a total of £11 15s. per week, which is still about £3 or £4 less than the weekly fees in hospital homes for the aged. The Minister says that as long as the invalid is receiving treatment comparable with the treatment that he would normally receive in a recognized hospital, he will be included in the benefits of the scheme. I hope that the interpretation placed upon this section of the bill will be broad and charitable. Here, a very great responsibility will fall upon the Minister.
Only a couple of miles away from where I live, there is an excellent home for old people, to which I have referred previously in this House. It is run by two nurses. It generally has in it 30 old people, one of whom, incidentally, is 104 years of age. She is a most remarkable old lady, and can carry on an intelligent conversation and read books or papers although physically she is quite feeble. But she is characteristic of the people whom you find in these homes. I would say that the two nurses who run the home are the nearest approach to angels that you could find on earth. Apparently you do not have to go to Heaven to be an angel. In institutions such as this, it is largely a matter of keeping the old people comfortable. Whether they are in a public hospital or not makes little difference. I feel that there should have been a more precise and definite approach to this kind of institution in order to give these people the same entitlement to hospital benefits as anybody else.
Finally, I want to refer to a field of medicine for which this bill makes no provision whatsoever. There is a system of therapeutics which is based upon the theory that disease is caused by interference with nerve functions. The Minister will know about this system. It is based upon the premise that ali the physiological and other processes of the human body are controlled and co-ordinated by the nerve system. Its therapeutics attempts to restore normal function of the nerve system by manipulation and treatment of the structures of the human body, especially those of the spinal column.
Daniel David Palmer, an American citizen, began to formulate this theory in 1895 and he established the Palmer School of Chiropractic at Davenport, Iowa, in 1903. Later, other schools were founded in different parts of the United States, and by 1941 the National Chiropractic Association had extended accredited ratings to twelve colleges teaching scientific courses of four collegiate years. The practice of chiropractic has been accorded legislative recognition in 42 States of the United States of America as well as the District of Columbia, Alaska, Hawaii and several provinces in Canada. It was estimated several years ago that there were 18,000 chiropractors practising in the United States and Canada. It is worthy of mention that the name chiropractic comes from Chiron or Cheiron, who, in Greek mythology, was one of the centaurs, the son of Kronus and Philyra, a sea nymph. He was famous for his wisdom and his knowledge of the art of healing. Accidentally pierced by a poisoned arrow shot by Herakles, he renounced his immortality in favour of Prometheus and was placed by Zeus among the stars as the constellation Sagittarius. Incidentally, the Prime Minister (Mr. Menzies) and I are Sagittarians.
A very celebrated Sydney gynaecologist many years ago visited the United States and there familiarized himself with the science of chiropractic and has since been associated with some very unusual cases. I myself years ago was smitten by spondylitis or arthritis of the spine and I reached the point where constantly recurring bouts of pain were so excruciating that I thought suicide was the only form of relief. Honorable members opposite may have cause to regret in a few years’ time that I did not commit suicide. Those who have suffered the excruciating agony of spondylitis or arthritis of the spine will appreciate that one feels there is only one way out - an overdose of morphine or death by some other means, so great is the pain. The particular gynaecologist of whom I am speaking is a member of the British Medical Association. He is a Macquarie-street man who learnt the science of chiropractic in the United States and who has attempted to apply it in Sydney. Fortunately, somebody who had been treated by him recommended him to me. For twenty years, I had been drinking bottles of medicine and swallowing thousands of pills. I had been subjected to deep X-rays, ultra violet rays and all kinds of other rays. After receiving treatment I was able to live free of pain and have been free of pain ever since, thanks to somebody in the ranks of the B.M.A., who knew something about chiropractic. I have known this man to leave his gynaecological practice in Macquariestreet at 7.30 p.m. to treat a large number of patients waiting for him at his practice in Castlecrag, Sydney. The Minister will know about whom I am speaking - the famous Edward Rivett. I used to see patients go to his hospital at Castlecrag so crippled with pain that they could only progress an inch at a time with somebody supporting them on each side, I have seen such patients enter the doctor’s surgery and emerge five minutes later walking quite free from pain.
There are at least 18,000 chiropractors in the United States and Canada. In those countries there are four-year collegiate courses in chiropractic, but there is still no recognition of this branch of medical science in Australia. It is time the B.M.A., of which the Minister is a member, recognized chiropractic, even as it belatedly recognized the science of hypnotism.
I desire to conclude with the hope that the Government will leave one type of drug at least free for all. I refer to tranquilizing drugs, because after the taxes imposed on our patience by a government very much upon the defensive, I feel that we aire sorely in need of the best tranquillizing drugs free of charge.
.- Mr. Deputy Speaker, I think we can say that in the debate on this bill some very good suggestions have been put forward by Government supporters as to the steps that might be taken, not perhaps in the immediate present, but in the not too far distant future with regard to the National Health Bill. Before commenting generally on the bill itself I feel that I should make one or two comments with regard to certain things that have been put forward by members of the Opposition.
I have been amazed at some of the incorrect ideas that members of the Opposition have, not only in regard to the effects this bill may have, but also as to the way in which our national health scheme has operated in the past. For example, the honorable member for Eden-Monaro (Mr. Allan Fraser) said that it was wrong in principle and morally to force people to join a society in order to obtain Commonwealth benefit. I think anybody with an appreciation of this bill, and of the act, will realize that no one could join a society only for a Commonwealth benefit. Everybody joining a society is eligible for both Commonwealth benefit and fund benefit on numerous occasions. Having said that I admit that there are perhaps a few occasions when the fund benefits themselves can be refused, but the Commonwealth benefit will still be paid - for example, a period spent in a convalescent home. But this is quite a different picture from the picture that was painted last night by the honorable member for Eden-Monaro. Even in a case where, for a particular reason, the fund benefit may not be paid, the Commonwealth benefit is adminstered by the fund. I feel that if we were to follow to a logical conclusion the argument that people should be able to obtain these benefits without making any contribution at all, we would find that it would be necessary to set up machinery to administer and record payments. That would be, in effect, a government machine that could not fail to be a rival machine to the fund scheme itself. I think that if such a system existed there would be enormous pressure on the mechanism of the system to handle all the benefit payments and therefore, following it a step further, there would soon be little or no incentive to join a fund and before long these funds would be out of business.
I recall that in this House last year the Minister for Health (Dr. Donald Cameron) said the same thing to the honorable member for Eden-Monaro in answer to the proposition put forward by the honorable member at that time. The Minister said that the proposals of the Opposition were tantamount to serving notice on the fund and that if Labour came to office and put into practice its scheme, it would put those people out of business. That might very well cause a complete decay, even if by degrees, of the friendly society movement. Later I will say something about people who are prepared to accept a degree of assistance also being prepared to accept a degree of responsibility.
I come now to another point - the rate of payment to the special account hospital fund contributor. This provision has, I believe, led to many misleading statements and conceptions. First of all, a contributor transferred to the special account will get whatever rate of hospital benefit he is insured for until he exhausts his maximum benefit period. After that he will drop to the standard rate of fund benefit, 16s. a day. Prior to the introduction of the special account he received no fund benefit at all after exhausting his maximum benefit period. If the contributor has been admitted to hospital for what is called a pre-existing ailment, he will be paid from the special account fund benefit at the rate of 16s. a day indefinitely. Previously, he received no fund benefit at all. The only qualification of these two provisions is that payments to patients from the special account cannot exceed the total daily hospital charge. I think every one will agree that this is quite reasonable.
Another point that has been made by honorable members of the Opposition, and one that I must say frankly I deplore, has constituted either a direct or indirect attack upon the medical profession. This is not the first time on which this has been brought up in this chamber, and I feel that it is most unfortunate. In any profession or any group of people one must confess that there are some men who have not, perhaps, the depth of character that others have. But if one considers the medical profession as a whole, not only in this country but also in many other countries, one must conclude that the community owes it a tremendous debt. I speak not only from experience as a patient, but also from experience as a minister of the church, extending over many years before I entered the Commonwealth Parliament. I believe that any slighting reference to the medical profession as a whole - and unfortunately in these comments the attack has been directed, in the main, at the medical profession - can only do harm to a profession that has made a valuable contribution to this country. I believe that anything that undermines the confidence of the public in the medical profession is detrimental to our community life.
I believe that a study of this bill will convince any one that it contains a great number of benefits, which will be enjoyed by the whole of the community and not by only certain sections of it.
Opposition supporters have made certain remarks about what they have called the iniquitous means test applying to people receiving a certain amount of income as well as a pension. Again, I think that if this provision is looked at with any degree of commonsense, it will be appreciated that a farcical situation was developing. Frequently a married couple receiving pension plus income were getting more than a man with family responsibilities. While the family man was prepared to accept his share of responsibility and contribute to a fund for the benefit of his family, the pensioner couple, whose income in some instances was higher, were receiving medical benefits free. The position was becoming farcical and something had to be done about it.
Having made those remarks about the medical and hospital benefits sections of the bill, let me say at this stage that the Minister deserves the congratulations of the House with regard to those portions of the legislation. I pass now to the subject of pharmaceutical benefits. Here, I believe, we have left ourselves open to a degree of criticism. I believe that the suggestions made by the right honorable member for Cowper (Sir Earle Page) and the honorable member for Paterson (Mr. Fairhall) are well worthy of consideration, and I understand that they have received the support of quite a number of honorable members on the Government side. While I realize that the suggestions cannot be accepted for incorporation in the legislation now before us, I believe that the Minister and the Government should give earnest consideration to them, because it seems to me that they provide the solution to this problem of spiralling costs, requiring as they do the acceptance by the people of a degree of responsibility.
As the right honorable member for Cowper pointed out, even the imposition of a charge of ls. for prescriptions in the United Kingdom did not slow down the cost spiral. It is obvious that when increasing the list of available drugs we must expect an increase in expenditure on the scheme. I, for one, believe that this increase will not be counteracted by the charge of 5s. for each prescription. I am glad that the scope of the scheme is being widened, because I have had the experience, as I am sure many other honorable members have, of interviewing people who were unable to afford certain costly drugs which were necessary for their treatment and which were not included on the free list. In this respect I cannot understand the argument of the Opposition that the Government is denying the use of these drugs to people who cannot afford to buy them. Surely, if more drugs are to be made available and the charge for each prescription is to be 5s., then over a period the average price paid by an individual for his prescriptions will be less than it was previously. A drug that was not previously on the free list might have cost a patient 25s. or 30s., whereas it will now cost only 5s. Surely it is obvious that such a person will receive a substantial benefit.
I have said that we have left ourselves open to criticism. I refer in this connexion to the pharmaceutical guild. I believe that the success of such a scheme as this depends upon what one might call the public relations of doctors, of chemists and of the Government. I believe that unless we reach an agreement with the pharmaceutical guild, then one of the legs of this structure will be damaged, if I may put it that way, and our public relations will be adversely affected as a consequence. I said that I felt it was right that we should ask people to accept a degree of responsibility. That is why I feel that we should devise some kind of insurance scheme to be operated along the same lines as the medical benefits funds or the hospital contribution funds. I believe that this would be better and probably more successful than the present scheme. We must face realities. We cannot be continually giving things to people without asking them to accept a degree of responsibility, because to do so would be to bankrupt, eventually, our national health scheme and social services scheme entirely. In this regard, I think that if we ask these people to accept responsibility, we are not asking too much. The taxpayer is being asked to pay a bigger amount; and, according to members of the Labour Party, if we ask him to meet all the costs, this will be done by the people who can afford it. I do not agree with that because, although people have to pay 5s. for each prescription, much of the cost is still met out of Consolidated Revenue.
Another factor which will have to be looked at is in regard to the chairman of this committee who, I believe, should be an independent person so that there can be some kind of proper balance. I do not believe that the present set-up is satisfactory to the pharmaceutical guild. We must always ensure that we do not put too much clerical work upon the chemists so that they have so much of it to do that it interrupts or delays the dispensing of prescriptions and at some stage they might even have to give it priority over prescriptions.
As I said before, I believe that the good points in this bill far outweigh any of the criticisms I have made and I feel, at this stage, that if the Minister and the Government will look at the matters which have been mentioned by members on the Government side, in the future legislation can be brought forward which will even improve this bill, which makes an improvement upon previous legislation enacted by this Parliament.
– First of all, I wish to refer to the remarks made by the honorable member for Lyne (Mr. Lucock) who suggested that members on the Opposition side were unduly critical of the medical profession. I want to say that they have not been so critical as have members on the Government side, including members of the Government itself. When it becomes necessary to impose a fee of 5s. per prescription on sick people because it has been suggested that prescriptions have been handed out in a frivolous manner, it is an attack upon the medical profession to say that this charge has had to be introduced as a deterrent against what amounts to a malpractice.
What I dislike about this bill, mainly, is the obscurity that cloaks many of its features. It is difficult to get information from the Minister for Health (Dr. Donald Cameron) when we ask questions. For example, I wanted to know whether the 5s. fee would be levied upon repeat prescriptions but I got no satisfaction. When we have tried to find out something more definite about the treatment of aged and chronically ill people and who, exactly, is entitled to the special funds benefits, this matter seems to be cloaked by obscurity.
We have been assured that there are quite a lot of things which might flow from the bill, but these, in actual fact, will be determined after this House has passed the measure. These decisions will be made later in consultation with the chemists’ guild and although this has not been said, possibly with the British Medical Association.
It is claimed, and I think not incorrectly, that in many respects the bill does not improve the situation which has existed. I think that claim can be substantiated. Although the bill will make some improvement, it does not go as far as members on this side of the House think it should. Attention has been drawn to the fact that people who are, unfortunately, afflicted with mental illness will still be treated as lepers under this scheme. Nothing is to be done for them. I should have expected, in view of the modern approach to mental illness, that some steps would have been taken towards the rectification of the problem, not only as it affects these people but also their dependants.
As to the 5s. levy - it is a levy because it is a tax imposed on a section of the people who are least able to bear it - I consider it is wrong, as any sectional tax is wrong. But it is worse when it operates against those least able to bear it. One honorable member referred to the benefits which might accrue from imposing responsibility on people. I suppose that this 5s. charge would be regarded as some sort of responsibility.
I wish to mention a case in my electorate in relation to the levy of 5s. The family concerned includes a small child of three years of age who has suffered, from birth, from a digestive complaint and it is necessary for this child, every day - and probably for all of its life - to be supplied with a preparation called “ Pancreatin “. This preparation can be obtained only with a medical prescription and the dosage at the present stage is such that one and a half prescriptions a week are used. Although that may sound odd, the fact is that the parents have to obtain two prescriptions each three weeks, because there is a limitation on “ repeats “. So the parents will pay 7s. 6d. a week in respect of the prescriptions, but I understand that as the child develops it will require greater quantities. The parents are in poor circumstances. They have given me their permission to supply the Minister or his departmental officers with the names of the doctor and chemist and all details, if required.
There are other patients who require insulin treatment but there is a limitation on the number of times their prescriptions can be repeated. Other patients require certain preparations for thyroid gland treatment, which is a continuous process. The imposition of this 5s. fee will come very heavily upon people in these circumstances and they are the least able to bear it. That is a condition that we should not tolerate.
I have been pleased to notice, as no doubt all honorable members must have noticed, a good deal of criticism of this 5s. impost coming from members on the Government side. In the main, the criticism has not dealt with the aspect that I have raised, but, because of the pattern that is always followed, I suggest that the criticism is the result of opposition displayed by the Pharmaceutical Guild to the proposals contained in the bill. As late as 6th October, Mr. Eric Scott, federal president of the Pharmaceutical Guild, wrote to the Minister objecting to the imposition of the 5s. charge, and, in concluding his letter, said -
I may add that if our proposal is approved by you, it would materially assist me in checking the increasing opposition to the scheme which I have noticed amongst members generally throughout the Commonwealth.
So, as late as 6th October, opposition from the pharmacists was increasing. I suggest that their requirements have not been satisfied even yet. Their approach to the 5s. charge is that they had a quite understandable fear that some of their members, in order to buy public goodwill and so attract customers from other chemists, might not collect the 5s. As a matter of fact, at some branch meetings of the guild, I noted that many chemists were unhappy about the prospect of being made public tax gatherers. They felt that this was not right, ethically. Representations were made and pressure was put on the Government to make the 5s. tax, as I call it, compulsory. Whilst the manner in which the Government has overcome this difficulty may not be illegal, it amounts to compulsion because if chemists do not collect the 5s. it is just too bad for them.
– They can charge-
– I suggest you are out of order, and I prescribe Beecham’s pills; they will not cost you 5s. either.
When the chemists seek recoupment, they will be paid the cost that is allegedly properly assessed less 5s. If that does not amount to compulsion or coercion, nothing does. If they do not make the charge, they will be 5s. out on what, after all, may not be a reasonable fee for dispensing the prescription. Whether it is, I think, is a matter that they are entitled to have inquired into because, although it is suggested that they are probably all millionaires, they may not be getting what the prescription is worth. In this regard, I refer to their request that section 99 of the principal act be brought more into line with similar provisions for members of the medical profession. These provisions are similar except in one respect. The provision relating to the medical profession requires that there shall be agreement between the Minister and the profession itself. This is quite different from the treatment given to the Pharmaceutical Guild. Here, a committee of nine members, four representing chemists and four from the department, with what is virtually a departmental chairman, deals with these matters. Very rarely do chemists get away with anything, and they claim that they are not properly recompensed. They suggest that the assessment relating to them should be made in the same way as the assessment relating to the medical profession, but they have learned very recently that they are only little people and are not likely to get the same treatment as the medical profession - or, for that matter, the shipowners.
We suggest that there should be at least an independent arbitrator, and I hope that an investigation will be made. If pharmacists are being paid too much, they should be corrected; if they are not being paid enough for their labour, then, as a trade unionist, I say that they should be given the proper amount, after investigation. I have referred to the obscurity that surrounds everything. I am, however, happy that there will be some improvement in the lot of the aged and the chronically ill. But I am not happy with the fact that many propositions put forward are so vague that it is almost impossible to assess the results of them. I repeat that the imposition of a charge of 5s. will cause hardships on those families that need a continuous supply of particular drugs, perhaps for years. It is an outrageous impost on people in those circumstances, and I hope that further consideration will be given to it.
.- The purpose of the National Health Act 1953 was to carry out the policy of the Government parties contained in the policy speech of 1949, which was -
To make social provision in relation to sickness on a contributory basis, free from a means test, and in which adequate medical services are within the reach of all.
The national health scheme then introduced was a voluntary contributory scheme, free of means test, which provided that those persons who make contributions to approved medical or hospital associations, when sick or in hospital, will receive in association or fund benefits plus Commonwealth benefits a substantial proportion of the hospital or medical fees incurred. The scheme has been an outstanding success and is to-day recognized as probably the finest medical and hospital scheme in the world.
As with all new acts, certain difficulties arose shortly after this act was passed. It was found that the aged and the chronically sick had difficulty in securing insurance. The hospital and medical associations regarded them as bad risks and, in many instances, were not prepared to insure them. These people, therefore, were unable to receive either the association benefit or the Commonwealth benefit. To meet this situation the Government passed an amendment to the act in 1958 which provided that medical and hospital associations should be permitted to transfer aged and chronically ill persons to what was known as a special fund which meant that those people were then able to insure with a fund and, being insured, were able to receive not only the Commonwealth benefit but also the fund or association benefit
The Government guaranteed these associations against any loss. In other words, the Government very properly threw upon the whole community the burden of any loss that the associations might incur in insuring aged and chonically ill people who, unfortunately, are more susceptible to sickness and more in need of hospital treatment than are younger and healthier people. The Government found it necessary to provide some line of demarcation between those who were in hospital because they were really ill, and those who were in hospital merely because of old age or infirmity and had nowhere else to go. The Government decided to draw that line of demarcation according to the kind of hospital in which the people had secured a bed- It, therefore, made two classes of approved hospitals - those which were recognized for fund benefit and those which were not. This again produced anomalies and hardship because some aged and chronically ill people were unable to get into public or recognized hospitals and were compelled to go into hospitals which were approved but not recognized and. although they received the Commonwealth benefit, they were ineligible for the fund or association benefit.
Some of us felt that this attempted solution of the problem was not satisfactory. We made representations to the Government, and I am delighted to see that the anomaly to which I have referred will be eliminated when this bill becomes law. We suggested to the Government that the nature of the illness, and not the hospital should be the deciding factor as to whether a person should receive the fund benefit. If a person were in need of hospital treatment because of illness, he should receive the fund as well as the government benefit provided that he was receiving treatment equivalent to the treatment that he would have received in a public hospital. This bill will remove the injustices and anomalies which have arisen since the passing of the amending act in 1958.
Section 10 of the existing act provides that fund benefit will now be payable to special account contributors, that is, the aged and chronically ill, in both recognized and non-recognized hospitals where the Director-General of Health authorizes the payment. The bill further provides that the Director-General shall authorize the payment - it is completely mandatory - where the special account contributor is suffering from illness or injury which requires hospital treatment of a kind provided in public hospitals, and where the treatment is of a standard substantially equal to that which the patient would receive in a recognized hospital. This amendment will be of immeasurable benefit to the aged and chronically ill. It has received the approval of people throughout Australia who have been extremely worried by the difference between the benefits payable to those in recognized hospitals and the benefits payable to those in hospitals not so recognized.
I congratulate the Government upon introducing this reform, and I thank the Minister and his colleagues for having acceded to the requests of those of us who have been particularly troubled by the relevant section of the act. We can say now without any reservation whatsoever that we have the finest national health act in the world. It is a truly national act; it provides for a contribution; it contains no means test; and it gives substantial help to insured persons to meet both hospital and medical expenses.
I support the action of the Government in prescribing a contribution towards pharmaceutical benefits. When people have to pay something out of their own pockets they will think twice before purchasing medicines unnecessarily. When medicines are free, there is always the danger that you will obtain pills or medicine without any thought of the cost. The proposed charge of 5s. is only small, but most people will think twice before they purchase medicines unnecessarily. I support the Government’s proposal because I believe it to be in line with the contributory policy of national insurance that the Government has laid down. I should like to see a scheme on the basis of the scheme that was proposed by the right honorable member for Cowper (Sir Earle Page) and several honorable members on this side of the House. If pharmaceutical benefits were supplied on substantially the same basis as are medical and hospital benefits, namely, that the people themselves make a contribution towards the cost, this legislation would be further improved. But while the Government is considering the views that have been advanced by the right honorable member for Cowper, the present proposal to make a charge of 5s. for each prescription will give stability to the scheme. It is in accord with the general policy of the Liberal Party and the Australian Country Party, both of which I support.
.- As is usual when I rise to participate in a debate, I wish to make some references at the outset to statements that have been made by certain honorable members. The honorable member for Eden-Monaro (Mr. Allan Fraser) has said that all hospital patients will have to pay 5s. for each prescription that is written for them. Of course, it would appear that “ all “ means “ every one “. But in the hospitals there are many pensioners. If the honorable gentleman had said that all hospital patients with the exception of pensioners would pay the 5s., he might have been right, but I do not think hospital patients will have to pay. Anyway, he was in a way veiling the real issue and not letting people know exactly what was happening.
I do not want to go over all the points in the scheme that have been mentioned. I want to deal with the scheme as it affects four different sections - the Government, the public, the doctors and the chemists. First, let me deal with the public. The pensioners will not be affected by this legislation.
– Those who have medical cards.
– The honorable member for Port Adelaide has interjected that only the pensioners with medical cards will not be affected. That is quite correct. But if a pensioner has not a medical card, that means that he is receiving only a part pension, because he has some other means. The general public, apart from pensioners, therefore, will now become entitled to a much wider range of drugs at a cost of 5s. per prescription. It appears to me that that will greatly assist in keeping up the high standard of health of this nation, because for a long time doctors have been restricted as to the drugs they may prescribe under the scheme.
Some honorable members claim that doctors have been prescribing too liberally. The honorable member for Eden-Monaro said -
Nowhere in the bill is a curb placed on the medical profession.
The honorable member for St. George (Mr. Clay) advocated some curb on doctors in this respect. In his second-reading speech the Minister said that the Government could see that there would be a greater charge on it when the scheme came into operation, and that the Government was not at all anxious to have, nor did it think it could have, such a scheme on the cheap. In fact, the Minister said -
It is from this very wide range of drugs and medicines to which I have referred that doctors will have a choice of what to prescribe for their patients, and within it a doctor will not be hampered in his medical discretion by any consideration of the cost of the prescription to the patient.
That is practically the opposite of what the Opposition is saying. The Opposition contends that there must be some restriction on doctors’ prescriptions; the Minister has said that the range should be as wide as possible so that the doctor can prescribe the appropriate drug for the ailment from which the patient is suffering. Of course, the Government could not possibly hope that with the wider range of drugs to be provided the scheme would cost less. The Government realizes that it will cost more; but the charge of 5s. is to be imposed so that the public might have a realization that they are getting something valuable. When you get something for nothing, after a while you take it as a matter of course and do not appreciate it. By paying even 5s. the public will realize that it is getting something that is valuable, although people will be paying only a small percentage of its real worth. That is really why the Government decided to impose this charge of 5s. per prescription. Of course, the charge will cut the cost to the Government to some extent, but this saving will be offset by the increased cost arising from the extension of the range of drugs. Honorable members on both sides of the House have pointed this out, so it appears that every one realizes that that will be the case.
It is my considered opinion that only a few doctors are prescribing drugs more or less lavishly. I believe that when a doctor examines a patient he generally endeavours to prescribe the best possible medicine or drug for the ailment. This bill merely widens the prescribing range, and therefore helps the doctor to bring back health to his patients. If we were to restrict the doctor in writing prescriptions, that restriction might occur in a case like that mentioned by the honorable member for St. George, where the necessary treatment or drug could not be given because the drug was not available on the pharmaceutical benefits list. The results that he talked about could follow, in many cases, in such circumstances.
The next, and the most important thing as far as I am concerned, is the position of the chemists. I believe that chemists are getting perhaps the rawest deal. The charge of 5s. has to be collected by the chemists. I have met a number of chemists in my electorate. I am pleased to hear honorable members on both sides refer to the high standard of the chemists in business and in their profession. Every chemist I know or have known is or has been a man of very high standing.
A certain proportion of a chemist’s business is concerned with free medicine for pensioners, a certain proportion is concerned with free medicine for the general public, and then there is the normal business of the chemist. With the extension of free medicine benefits, as they apply to the general public, to cover the range available to pensioners at present, the normal business of the chemist will be restricted tremendously. The chemist will have to collect the 5s. prescription fee. He will not be collecting it for the Government, as has been said by some honorable members, but will be collecting it for himself, because for every prescription the Government will pay 5s. less than heretofore.
It has been said to me that perhaps a small boy will come along with a prescription for his mother, who is very ill, but without having with him the money to pay for it Is the chemist to tell the boy to go back home and get the 5s. before he will give him the prescription? No! His professional ethics would not allow him to do that, because it is a matter of urgency that the prescription be filled. So he gives the lad the prescription, and still has to collect the 5s. In the town where I live, a prescription may be ordered by telephone and the chemist asked to send it three or four stations along the line. He may not see the patient for whom the prescription has been written for quite a long time, and he still has to collect the 5s. Some one has said to me that if there were no free medicine scheme, the chemist would still have to collect all the money for the prescription in such a case. That sounds all right at first, but the real point is that if there were no free medicine scheme the chemist would be carrying on his normal business, charging a higher rate for prescriptions than the Government is paying, and, like any other businessman, would be making some sort of provision for bad debts. But when the Government is paying what is considered generally by the pharmacy profession to be a low rate at present, and with the range of drugs under the scheme being extended - which will result in a restriction of the normal business of the chemist - there is no chance of the chemist making provision for bad debts. So, from the very start of the negotiations with the Minister, and at the meetings that we have had in party rooms, I have advocated that the basis of this is the pricing, the cost, and what the Government is prepared to pay to the chemists.
On two occasions, I have asked the Minister whether he considered that these negotiations could be brought to a successful conclusion in order that the chemists might be satisfied with the amount they receive for making up these medicines under the scheme. On each occasion, the Minister has replied, “ Yes, I am perfectly satisfied that we can make satisfactory arrangements”. The present negotiations have been going on for some time. I would have been much more pleased if they had been finished before this bill went through the Parliament. We should then have known just where we stood, whether the negotiations bad been successful and whether the chemists throughout Australia were satisfied with the deal that the Government was prepared to give them. However, the negotiations are still going on, and I have complete faith in the Minister. I think that, when the Federated Pharmaceutical Service Guild has set out what the chemists desire - and perhaps after further negotiations - the Minister will come to an agreement pleasing to both the Government and the chemists. That is the main basis of the scheme, and I strongly urge the Minister to reach agreement with the guild.
I recently visited a chemist’s shop and went to the room where medicines were dispensed, in order to see what was happening. I learned that there is considerable wastage of drugs. The chemist pointed out to me rather a large jar, and indicated that its contents had cost twelve guineas. He said that the doctors had been prescribing the drug in tablet form, but had ceased to write prescriptions for it. As a result, he was left with what remained on his hands. He pointed out other drug containers the contents of which he still held. He said, “ There is a great deal of waste. Unless the doctors in our town start writing prescriptions for these drugs, I shall be left with them. That will cause me a big loss. “ All these things must be taken into consideration. Also, a chemist whose business is too big to be run by himself, and who has to employ staff, finds that his expenses are as high as, or even higher than, those of any profession or business on a similar scale anywhere in Australia. Every one knows that you have to pay big money in order to get a man with the necessary qualifications. In view of these circumstances, I am particularly anxious that the Government look to the pricing and the allowances made to chemists for the making up of these prescriptions. The payment to the chemists should be adequate and satisfactory, because chemists play such an important part in maintaining the health of the people of Australia.
My attention has been directed to several other matters. The honorable member for Port Adelaide (Mr. Thompson) objected to a patient having to go to an ordinary general practitioner to be referred to a specialist. I think that is quite proper.
If every one went straight to a specialist without being referred by a general practitioner, people would probably be going to doctors who were not specialists in the ailment involved. Secondly, these people would be cluttering up the consulting rooms of specialists and preventing them from treating other people suffering from the diseases in which they specialize. If, on the other hand, a patient goes first to a general practitioner, the general practitioner finds out what is wrong with him and sends him to the appropriate specialist. Time, money and trouble are saved. The skill of the specialist is made available to many more people who need it.
Another matter which has been brought to my attention concerns clause 21, which provides for the insertion in the principal act of proposed section 104a. This proposed section empowers the DirectorGeneral of Health to require a chemist to supply particulars of his stock on hand at any time. The chemist must comply with the demand within a time which may be specified by the Director-General. I do not think that the Director-General will use this power to any great extent. I have been asked to protest against this provision, but it is my considered opinion that there is no need to worry about it. Surely we have enough faith in the Director-General of Health to know that he will not demand that chemists supply particulars of their stocks every few weeks. He will ask for this information only when it is absolutely necessary. Although I have been asked to protest against this provision, I am not prepared to do so, because I have enough faith in the Director-General to know that he will not harass chemists by asking them to make reports every few weeks concerning the stocks of drugs that they have on hand. If any chemist was harassed in this way and he brought the matter to the notice of myself or, I think, of any other member on either side of this House, the case would soon be aired in this chamber and we should soon get it straightened out. The harassing of chemists in the way that is envisaged is unthinkable, and, therefore, I do not consider that the protest against clause 21 warrants my support.
My attention has been directed, also, to the fact that the rates of payment to chemists may be varied by the Minister.
Proposed sub-section (1.) of section 99 of the principal act, in clause 18, provides -
The Minister may, after consultation with the Federated Pharmaceutical Service Guild of Australia, determine -
the rates by reference to which, and the manner in which, the Commonwealth price of a pharmaceutical benefit is to be ascertained . . .
I have been asked to support a suggestion that this sub-section should read -
The Minister may, after consultation and agreement with the Federated Pharmaceutical Service Guild of Australia . . .
I think that would be very nice. However, one possible objection occurs to me. If the Minister could not reach agreement, there would be a deadlock. Therefore, I do not support this suggestion, although I think that consultation with the guild is necessary.
Perhaps the chemists have a legitimate complaint in respect of the standing committee, on which there are four members of the guild, three members who are really employees of the Department of Health, and one member who is a Treasury official - a total of eight members. One of the employees of the Department of Health is chairman. Most chemists would prefer an independent chairman. But the real point is that the Government will not allow any of its instrumentalities throughout Australia to take control out of the Government’s hands. On any board that one cares to name - an agricultural board, a wheat board or any other kind of board - the responsible Minister has the final say. The chairman represents the Minister. I put it to the Minister that, in this instance, it would be quite reasonable if the chairman were some one other than an employee at the Department of Health. He could still represent the Government. I think that would be a workable arrangement and that it would be a great advantage. I make this suggestion with the best of goodwill, in the hope that the Government will take some notice of it.
I should like to sum up by saying that I have dealt with four parties to the national health scheme - the public, the doctors, the chemists and the Government. First of all, I believe that the Government is doing the best it can to give the people of Australia better medical benefits. Let me deal, secondly, with the doctors. I believe that very few doctors in Australia are prescribing more or less at random and trying to heap great expense on the Government. I suggest that those who are doing this are only a small minority. The standard of the profession is so high that this sort of thing would not be done to any great extent. Some one has said in this debate, “ Any doctor will tell you of his colleagues who are prescribing much more than is necessary “. I cannot believe that. It does not seem to me to ring true. I am sure that no doctor would talk about what his colleagues were doing. On the whole, I think that we should be mighty proud of the doctors of this country.
– There are good and bad everywhere.
– I believe that is correct. But I believe that everywhere the bad are in the minority - and a very small minority.
The main point that I want to make on behalf of the chemists is that the Minister for Health must see that they receive adequate pay for their work for the Government. They must keep their work on a high standard. That cannot be done in this country with its rising costs unless the chemists get enough money. These men have shops and businesses and are working for the Government. Their normal business is being restricted and they will have bad debts in respect of the 5s. fee. They cannot provide for their bad debts at the present time and the Government must see that the money that it pays to them makes provision for bad debts.
I think that members of the general public are receiving the best deal that they have ever had. Opposition members have stated that they do not think that this voluntary contributory scheme is good. Probably, it has many faults. But I can say to the Opposition, to the Government, and to the people of Australia that it is the best health scheme that we have had in this country and that this bill will improve it. Taking all in all, the main point that I want to make to the Minister is that the price paid to the chemist must be adequate. I ask him to concentrate on that and to do all that he can to bring to a successful conclusion the negotiations that have been going on for some time.
.- First of all, I want to express my entire disagreement with the statement of the honorable member for Mallee (Mr. Turnbull) that the Labour Party stands for the restriction of the right of private doctors to prescribe. If there is any interference with the right of doctors to prescribe it is occurring at the present time under the pensioner medical scheme. I bring to the notice of the Minister for Health (Dr. Donald Cameron) a matter which I have raised with him before. That is the prescribing of the drug butazolidine, generally referred to as BTZ This drug has been largely used by doctors for the treatment of rheumatic and arthritic conditions. Recently, instructions were given to remove it from the pensioners’ list. Two other drugs which I think have a quinine base were put in its place. The doctors who have made representations to me on the matter have made it clear that they found butazolidine did a much better job to relieve arthritic and rheumatic complaints than the two drugs which have taken its place. I made representations to the Minister because, as one who has suffered from arthritis, I know the pain that it brings and I think that if there is anything that will relieve it quickly, persons who otherwise would have to undertake treatment lasting up to a month before obtaining relief, are entitled to have it prescribed for them. Whilst the two drugs that have been substituted for butazolidine may be cheaper, if butazolidine does the job better the pensioner should have it, and the doctor should not be compelled to prescribe another drug.
I want to make it clear to the House that the Labour Party believes that any national health legislation should impose on the Commonwealth Government the responsibility of putting into operation a health scheme which will be both preventive and curative. The ‘task of a health scheme is to do whatever is humanly possible to give the people the greatest possible measure of good health. One is rather surprised, when reading the Minister’s second-reading speech, to find that the question of cost is constantly raised. The cost does not matter so long as we are a healthy people.
Apparently everybody has lost sight of the fact that the economic implications of an adequate national health scheme are of untold advantage. If one were to compare the statistics for days gone by with those for to-day one would find that absences through sickness in industry are by no means as great in proportion to the number of persons employed as they were. The economic value of a health system under which people who take ill can be readily treated is that their absence from work is short and their skill and know-how is rapidly brought back to industry. That is something which should be remembered and prized. If it costs money to do that, the better economic position of the nation enables the community more readily to meet the cost than if the system were not in operation.
So, I suggest that we have to consider, first, not so much the cost of the scheme, but its value to the nation. I can recall in the early days of my association with industry any number of cases in which sick persons continued at work because their income was low and they had no resources behind them. They continued working until they could not work any longer. What was the result? Very often, they were subject to very long periods of absence from work as a consequence of their illness. Sometimes a worker reached such a state, particularly with pneumonia, that there was very little chance of recovery. So, whatever it costs the nation, there is a corresponding gain of great value to the community as a whole.
It has been stated that the taxpayers’ interest is being protected. The taxpayer is to-day paying for health benefits. He is the person who bears the burden of any health legislation that we pass. Therefore, the taxpayer is entitled to say, “ I desire to secure from this health scheme the very best medical attention, the very best hospital attention and the very best pharmaceutical benefits that can be made available to me “. If the taxpayer does not get those things he is entitled to complain, to object, and to make his objections heard.
Having said that, I want now to get on to two provisions of the bill which, in my opinion, are controversial. I shall deal, particularly, with hospital benefits and pharmaceutical benefits. In respect of hospital benefits, I want to draw the attention of the Minister to a statement which he made in his second-reading speech and which I feel gives a very wrong impression of the position of persons who are in benevolent homes, rest homes and similar institutions. So that there can be no misunderstanding, I shall read from the Minister’s speech. He said -
Notwithstanding the very limited way in which these homes can be regarded as hospitals, the Commonwealth has nevertheless always accepted their patients as hospital patients for the purposes of payment of Commonwealth hospital benefit and, accordingly the patients in these institutions who are insured with a registered hospital benefits organization have been, still are, and will continue to be entitled to payment of Commonwealth hospital benefits amounting in all to £7 a week.
I agree with that. That amount is being paid in respect of benevolent homes and similar institutions. But I take exception to the Minister’s next statement, which is -
Many of these patients are social service pen.sioners and are thus entitled both to pension payments amounting now to £4 15s. a week, as well as Commonwealth benefit of £1 a day, if insured, thus giving them altogether £11 15s. a week from the Commonwealth towards the cost of their accommodation in these institutions.
The position in Victoria - I presume this is the position in other States as well - is that there are two types of patients in the benevolent homes. First, you have what are called ambulatory patients - those who are able to get about and look after themselves. To them, the benevolent home is their home. Those patients pay a certain portion of their pensions to the home for their maintenance and they receive a small amount for themselves. But in respect of patients who are in the infirmary wards - patients who are unable to look after themselves and who require nursing and occasional medical attention, X-rays and so on - £7 a week is paid to the benevolent home, but no payment whatever is made by the pensioner in respect of his maintenance in the home. So instead of a portion of the pension being available to the institution in addition to the £7 a week, only £1 a day is available to it and no payment in respect of his maintenance is made by the pensioner who is in the infirmary ward.
I make the point that persons who are suffering from chronic diseases or conditions that require them to be in bed for long periods are entitled, as human beings, to receive exactly the same consideration and attention as any other section of the community. I cannot see why the payment for maintenance of a person who is so infirm and unable to look after himself that he must enter a benevolent home should be £1 a day when the payment for a person in a hospital recognized by the Department of Health is £1 16s. a day. I concede that perhaps the benevolent homes do not have X-ray facilities, but the benevolent home with which I am most closely associated - the Bendigo Benevolent Home - has its own doctor who visits patients. Patients in that home receive careful nursing attention and their needs are catered for in every respect. If urgent medical attention is required they are admitted to the Bendigo Hospital, next door, and at the earliest possible moment are returned to the benevolent home. A payment of only £1 a day to institutions looking after that type of person is totally inadequate and not in accordance with the standards that we as Australians believe they should have. As human beings, they are entitled to the fullest possible consideration under any Commonwealth health scheme. I express my intense dissatisfaction with what is taking place with regard to benevolent homes.
Then you have the hospitals that are registered as hospitals, which are attended by doctors and which accommodate patients who are suffering from chronic diseases and other illnesses. But because those patients constitute a fair proportion of the inmates of the hospitals - I am referring particularly to a hospital in my electorate called Mr Carmel - the hospitals have been denied, in respect of those patients, certain advantages that have been prescribed in the legislation. It may be that this legislation will cover a hospital of that description. I endorse the plea that was made to-night by the honorable member for St. George (Mr. Clay) that the clauses of the bill that are under consideration will be interpreted and administered in a generous and charitable spirit, so that hospitals that are doing a good job will receive the financial assistance necessary to enable them to carry out their activities properly.
I desire now to deal with pharmaceutical benefits. Like many other honorable members, I express my complete opposition to the proposal that a charge of 5s. be made for all future prescriptions dispensed by chemists under the pharmaceutical benefits scheme. I shall certainly vote against this proposal in the committee stage, and I hope that it will be defeated Of all the proposals that have been placed before us in this measure, the proposal dealing with pharmaceutical benefits is that upon which the least information has been given to the House. We are told that a charge of 5s. is to be made for a prescription. We are told that the cost of the pharmaceutical benefits scheme has been rising year after year, and that within the foreseeable future it may amount to £30,000,000 a year. But no indication has been given to the House of the average cost of prescriptions under the scheme. We have no information as to the cost of prescriptions paid for by patients in the course of twelve months. We have no idea of the magnitude of the work involved in the matter, and we certainly have no information whatever from the Government as to how much it is anticipated will be obtained by the introduction of the 5s. charge for prescriptions.
When the Treasurer (Mr. Harold Holt) submitted his Budget, he made it clear that persons suffering from chronic illnesses who had to have prescriptions repeated would not be required to pay 5s. in respect of each repeat prescription. But under the legislation no exceptions are made. A fee of 5s. is to be charged in respect of every prescription. A complete change of front has taken place between the making of the Treasurer’s statement and the drafting of this bill. No reason has been given why the promised alleviation has not been forthcoming.
I want to make it clear - I think it is necessary to do so - that although a good deal has been said about the pensioner medical scheme, not every pensioner is able to receive the benefit of it. Although the legislation of 1953 provided that all persons then in receipt of pensions were to be entitled to the advantages of the pharmaceutical benefits scheme for pensioners, it brought into operation a means test for future pensioners. Any pensioner who is receiving £2 a week in addition to the pension of £4 15s. is denied the right of participating in the pharmaceutical benefits scheme. So it will be seen that persons in the low income group will be hit by the introduction of the 5s. charge for prescriptions.
The Minister stated in his speech some of the possible reasons why the pharmaceutical benefits scheme was costing extra money. I should like to point out that there are very few instances in which greater changes have taken place in respect of any matter giving service to the people than in regard to the drugs which are now used for curative purposes. I suggest that a new era in medicine started entirely as a consequence of the development of the sulphanilimide drugs. The sulphanilimides which brought in a new method of attacking disease, particularly diseases which very frequently cost people their lives, were followed by the introduction of penicillin. Penicillin was a further advance and because its use resulted in bacteria and germs becoming resistant to it, it became necessary for pharmaceutical science to tackle the whole question from entirely new angles so as to evolve drugs which would be able to deal with the resistant germs. The consequence of all this has been the evolution of many types of drugs used for very many purposes aimed to give, in the shortest possible time, relief and cure from disease and restore the person concerned to normal health.
As a result of this advance in pharmaceutical science, the cost involved in the preparation of these particular drugs has become exceedingly high. I say quite frankly that chemists are giving to the Government of Australia to-day service in respect of pharmaceutical benefits at an extremely reasonable price and in my opinion it is entirely unfair to place upon them the burden of having to get themselves into difficulties with the public over the payment of 5s. for each prescription.
If any medical or health scheme is to be of benefit to the community, it involves cooperation between three essential groups. There is, first of all, the Government which may lay down the laws and plans in respect of health. But any scheme which the Government introduces has no possibility of success unless, with that scheme, it has the full co-operation of both the medical profession and the pharmacists.
One must say that from the inception of medical benefits, away back in the 1940’s, the chemists, throughout all the intervening period, have given the fullest co-operation to whatever government was in power at the time their co-operation was being sought. It has been given freely and in full measure and for that reason I feel that in the particular alterations now being made the Government of the day should show its appreciation of the co-operation given by the pharmacists by at least treating them in a manner which will enable them to be free of a good many of the difficulties they are experiencing at the present time.
There are certain proposals in this legislation which I think are entirely unfair. One was mentioned by the honorable member tor Mallee (Mr. Turnbull). I refer to clause 21 which provides for a new section, 104a, to be inserted in the principal act. With the comments that were made as to the undesirability of this particular provision and expressed, to a certain extent, by the honorable member for Mallee, I agree. Personally, I can see no reason why it should be in the legislation. The order contained in the proposed new section 104a is as follows -
The Director-General may require an approved pharmaceutical chemist to furnish to him, within a time specified by him and in accordance with a form supplied by him and with any directions contained in the form, a statement, signed by or on behalf of the approved pharmaceutical chemist, setting out particulars of stocks of drugs or medicinal preparations in his possession or under his control ….
That means an enormous amount of work for the chemist. It means that practically every time the request is made he has to take stock of all the things that he has on his premises which could be used in connexion with the pharmaceutical benefits scheme. There is no suggestion in this provision that there shall be any payment for the work involved. There is only a direction that the work shall be done and if it is not done to the satisfaction of the Director-General then appropriate action can be taken by the Minister or his department. Whether that provision will be carried out in a reasonable manner or in an unreasonable manner, nobody can say. But the point is that the provision is there and one never knows how it cnn or will be used in order to embarrass a chemist.
The next thing I wish to point out is that this proposal in regard to the 5s. fee for prescriptions might well wreck the whole scheme of pharmaceutical benefits. At the present time the chemists are very dissatisfied with the deal they are receiving from the Government. The Minister may be making some progress in his negotiations with them. Whether he is or not I do not know; but I do know that the chemists are exceedingly dissatisfied with the treatment they are receiving compared with the medical profession.
As to the medical profession, the bill provides that matters affecting the doctors have to be the subject of consultation and agreement; and unless agreement is reached no alteration which will affect the doctors can be made. But with respect to the chemists, there is no such provision. They can be consulted and their views heard, but after that the Government is in the position of saying, “ We will do this or that “ and the chemists have no further say in the matter. On the advisory committee, as was pointed out also, I think, by the honorable member for Mallee, there are to be four representatives of the Government and four of the pharmacists with one government member as chairman who has the deciding or casting vote.
I know that in the industrial world, it there were a dispute between employers and workers and if a group were appointed for the purposes of settling it, consisting of four workers and four employers, with an employer having the right to give the casting vote to decide the issue, we would have considerably more industrial disputes in Australia than is the case. It is obviously unfair that a person who is employed by an authority which is interested in the matter should have the casting or the deciding vote in the matter. 1 sincerely hope that action will be taken to see that if there cannot be consultation and agreement with the chemists, their matters can be decided by an authority with an independent chairman or arbitrator. This will enable justice to be done.
In the few minutes left to me, I want to say this, and I make no apology for doing so: I believe that in every nation the fight against disease should be carried on with unrelenting vigour. That is not a phrase of mine; it is taken from the Declaration of Philadelphia. The fight against disease must be carried on with unrelenting vigour within the boundaries of each nation. I believe that it is the function and the task of the government of the day to see that everything necessary is done to give every man, woman and child in Australia preventive or curative medicine and necessary hospital or other treatment free of cost to themselves. We say that education is essential for the progress of the nation, and education is free. Two things are necessary for the progress of the nation - education and health. Both should be free. Both should be the right of every member of the community, and Opposition members will never be satisfied until a health scheme is introduced here that entitles everybody from the day of their birth to the day of their death to the fullest measure of treatment in respect of their health, so as to build and maintain a healthy and strong nation.
.- The honorable member for Bendigo (Mr. Clarey), like all members of the Opposition who preceded him, extolled the virtues of a nationalized health scheme and condemned the health scheme that has been proposed and carried into effect by the Government. The right honorable member for Cowper (Sir Earle Page) has already pointed out in the course of the debate that the Commonwealth Parliament does not have the power that would enable it to put into effect a nationalized health scheme, even if it wished to do so. The gaps in the Government’s scheme have been grossly exaggerated by all Opposition members. For example, there has been no word of praise of the scheme which has largely eliminated and will ultimately eliminate completely tuberculosis in this country. That is a very great achievement.
– You inherited it from the Labour Government. What are you talking about? Why don’t you wake up?
– This Government has had to provide the money for it and that scheme has -been a tremendous success. Now there is another scheme, and I think that the honorable member who has just interjected will noi deny that this was not inherited from the Labour Government. I refer to the very vigorous measures which were taken by the Government to deal with poliomyelitis. I presume that the Opposition will not deny credit to the Government for that achievement. They were two great scourges with which the Government has dealt.
The scheme instituted by the Government is very well fitted to our circumstances, and I should like to quote a few words from a book written by Mr. Walter Hagenbuck in 1958 called “Social Economics”. He referred to the choice that the British Government had at the time it instituted a nationalized system. He said this -
Could not the gaps have been filled by an extension of health insurance? . . .
He went on to refer to other methods which could be used, and stated -
Would there not still have been a useful field for private practice and voluntary hospitals, to offset the dangers of top-heavy organizations, political influence, and restricted freedom which sometimes arises in comprehensive national institutions? The answer is probably: Yes, had it not been for the experience of the war. It was that experience which prepared the ground for the acceptance of the national health service proposed in the White Paper of February, 1944. The danger of air attack necessitated, during the war, a nationally organized system through which medical services and equipment could be immediately applied where they were most needed.
He also said -
Distinctions, real or imaginary, between different classes of people, became meaningless in face of air-raids. . . .
And again -
All this was of tremendous importance at a time when post-war reconstruction was widely regarded as a job which would command the same national solidarity as had the task of winning the war.
He clearly envisaged that at the time the British Government decided to institute a national health system, it could equally, and with certain other advantages, have instituted a scheme of health insurance such as we have in Australia. The reason the British Government made the decision it did was due entirely to the circumstances of the war, involving air raids in the United Kingdom. Those circumstances do not apply here, and the system that we haveinstituted is the one that is more consonant with our traditions, our customs and theform and practice of our health system.
The honorable member for Bendigo, again like all other members of the Opposition, while giving no credit to the Government for the gaps that it has filled in the scheme of national health, has thought of a large number of other free services that might be provided- The honorable member for Hughes (Mr. L. R. Johnson) this afternoon thought of a great many more.
It is easy for any member of the Opposition, for any member of this House, for any member of the public and for any person with a little imagination to think of 101 ways in which more free health services might be provided. Why are not these services provided? They are highly commendable; why are they not done? In 1956, the Guillebaud Committee in the U.K. was appointed - to review the present and prospective cost of the National Health Service.
At the end of its report, it made a comment which is very relevant to our situation or to the situation of any country contemplating a health scheme, or, indeed, any other expenditure. It said -
It is clear that the amount of the national resources, expressed in terms of finance, manpower and materials, which are to be allocated to the National Health Service, must be determined by the Government as a matter of policy, regard being had to the competing claims of other social services and national commitments, and to the total amount of resources available.
Of course, we could improve the national health scheme in many ways with the expenditure of large sums of money. Of course, we could improve housing condi tions or defence arrangements and many other matters, if we had unlimited money. But the task falls on every government to allocate limited resources. I believe that the Government has obtained the best value for its money by expending it in the way that it has on the present health service. I do not propose to say any more on that matter. The scheme is a good one. It has, I think, been accepted by the people and they are glad to have it.
The honorable member for Bendigo then spoke about the failure of the Government to provide by this bill for those inmates of benevolent homes who might for a time have to be placed in the infirmary attached to those homes because of real illness. Had he read the speech of the Minister for Health (Dr. Donald Cameron) he would have read this paragraph -
The new definition will in addition provide that individual patients in homes which are not eligible for recognition will be entitled to payment of special account fund benefit, when they can establish, first, that they were suffering from an illness or injury requiring the treatment of the kind provided in public hospitals; and, secondly, that the treatment provided was of a standard substantially equivalent to that which they would have received in a recognized public hospital.
In other words, if an inmate of a benevolent home is for the time being placed in the infirmary attached to that home and is receiving what amounts to hospital treatment, a special application can be made for the patient to receive the full hospital benefit.
The honorable member for Bendigo complained of the imposition of the 5s. charge for medicine. What appears to be overlooked by members of the Opposition is that this is not a 5s. charge that is imposed and has become a new burden on the people; the fact is that they will benefit from it. Formerly, they were paying more than 5s.. The result of this scheme will be that the Government will in fact be handing out more money for drugs than it did in the past and, of course, the public must get the benefit of that. They are not being compelled to pay 5s. when they paid nothing before; they are being permitted to pay 5s. when formerly they would have had to pay much more. Therefore, I cannot agree with the honorable member for Bendigo that this is a great imposition on the people. Indeed, it is precisely the reverse.
He is on firmer ground when he speaks about those people who are precluded from the benefits of the pensioner medical service because, in addition to their pension, they have an income that exceeds £2 a week. Those people who just fail to qualify for the pensioner medical service are in very poor circumstances. This means test was imposed in 1955, and as inflation in the interval has marched on to the extent of approximately 12 per cent, the limit of £2 should be increased to at least £2 5s. merely to keep pace with inflation, quite apart from whether one regards the £2 as having been a reasonable figure in 1955. So the honorable member, although he did not draw the conclusion that I have drawn, is on firmer ground when dealing with this subject.
I have not the time to pursue his arguments any further. He, like other honorable members opposite, had a great deal to say about the impositions upon pharmacists. The Minister is in negotiation with them, and I believe that some satisfactory arrangement will be reached. The honorable member for Bendigo complained that pharmacists are in a minority on the committee that, advises the Minister in relation to charges. Somebody has to decide these matters, and I suppose the honorable member would not expect that the pharmacists should write their own cheque.
– No, but I want an independent arbitrator.
– The honorable member wants an independent arbitrator on the committee. That may be a reasonable proposal, but I think that we should wait until the negotiations are concluded. We may then find that agreement has been reached.
Having referred to the speech of the honorable member for Bendigo, I now pass to some of the matters that I hope to mention in the time that remains to me. This bill does several things. It makes certain amendments to the medical benefits scheme. It increases the Commonwealth contribution to the funds of the medical benefits organizations by £425,000, and it does it in such a way that increased payments will be made on 140 items that appear on the relevant schedules. For instance, in respect of major surgery the benefit payable to the contributor will be increased from £30 to £60. For a very good reason I congratulate the Minister on having done this. When participating in the debate on the amending legislation on 23rd September, 1958, I urged that the benefit payable for major surgery should be increased, and I am gratified that it has now been done.
In 1954-55 the Commonwealth contribution towards the cost of doctors’ bills was 30.9 per cent, of the total account. Through inflation, this proportion fell to 28.5 per cent, in 1958-59. Had the proposed additional contribution of £425,000 been made in the financial year 1958-59, the proportion would have been restored to 30 per cent. It is evident, therefore, that the increased amount that the Commonwealth will now make available will restore the Commonwealth contribution towards the cost of medical accounts to the proportion that existed at the inception of the scheme. I believe that the Government is restoring the proportion in the best possible way, that is, by providing increased benefits where they are most needed, because we all appreciate the high cost of major surgical operations.
I wish to deal now with the criticisms that were made by the honorable member for
Eden-Monaro (Mr. Allan Fraser), who led the debate for the Opposition. He said that the proposed increase would be gobbled up by the doctors. What I have to say may not be a matter of very great interest to honorable members, but I have approached this aspect in an entirely academic spirit in an endeavour to find out in a purely scientific way and without any desire to find one answer rather than another, whether in fact the doctors, since the inception of the scheme, have gobbled up the Commonwealth contribution. I can prove to the satisfaction of the House, or to the satisfaction of those honorable members who choose to read what I say, that the medical profession has not exploited the public purse. Of course, particular instances would be no basis for making a judgment. How then does one assess the increase in doctors’ charges? The total amount paid to doctors by fund patients in 1954-55, which was the first full year of the operation of the scheme, was £13,584,716. That figure rose to £27,309,455 in 1958-59. Of course, that does not mean that fees have doubled. They have not. The number of fund patients has increased greatly in the interval. The primary contributors to the scheme in 1954-55 - of course a secondary group benefited, namely, the families of contributors - numbered 1,665,524, and this figure increased to 2,666,984 in 1958-59. Can it be assumed that exactly the same increase was evident in doctors’ services for each patient during that period? Of course, it cannot. On the average, in 1954-55, 6.215 services were provided for each patient, and in 1958-59 the number of services was 6.487.
Obviously the relevant matter that must be taken into acount is the increase in the average cost per service. In 1954-55 the average cost was £1 9s. Id., and by 1958-59 it had risen to £1 12s. 9d. That represents an increase of 12.6 per cent. However, a correction must be made to meet the decline in the value of money in the interval. The Statistician’s C series index rose from a figure of 2,678 in 1954-55 to 3,024 in 1958-59. This represents a rise of 12.1 per cent. I have come to the conclusion, therefore, that doctors’ fees rose by 12.6 per cent, and the value of money declined by 12.1 per cent. Clearly, fees have risen by no more than the decline in the value of money. There has been no exploitation by medical men.
The honorable member for Eden-Monaro made a charge that has been bandied about by other honorable members opposite. The figures that I have given are a complete refutation of that charge. If honorable members opposite are not interested in the honour of the medical profession, I am. However, the Commissioner of Taxation should make a study of this matter and submit a report each year similar to the report that he submitted in 1955-56 in relation to the earnings of various professional people,, including medical men, for the year 1952-53. If the commissioner were to do so, charges of this kind would not be made, and it would be evident that these insurance funds are not being exploited.
Now I pass on to the second matter with which the bill deals - hospital benefits. This measure extends full hospital benefits to patients of institutions formerly excluded under the definition of “ recognized hospital “. Again I congratulate the Minister on this matter, because it was one that was taken up with the Minister by a number of members on this side of the House. It is a matter about which I myself have spoken in the House, and I am glad that the Minister has seen fit to correct the position.
The honorable member for Eden-Monaro, who led for the Opposition in this debate, took for the Opposition the whole credit for this amendment to the law. Now, Sir, let us get the facts straight and put them on record. Some one may even read them. The fact is that the Opposition knew nothing about this proposal until they heard some rumours that honorable members on this side of the House were concerned about it and were seeing the Minister about it. The Opposition then put on a debate in the House which clearly showed to anybody who listened to it, or read the report of it, that they did not know what the matter was all about. However, the honorable member for Eden-Monaro, in the course of this debate, claimed the credit for this amendment - credit which belongs, like the credit for so many other improvements and reforms introduced in this Parliament, to the back benchers on this side of the House who do the job that the Opposition should be doing.
– Were you responsible foi abolishing free hospital treatment?
– Order! I will be responsible for abolishing something else. There is too much noise in the chamber.
– Clause 10 (b) reads-
Section eighty-two E of the Principal Act is amended - by adding at the end thereof the following sub-section: - “ (2.) For- the purposes of paragraph (h) of the last preceding sub-section -
the Director-General shall recognize, for special account purposes, an institution that is a public hospital or an approved private hospital unless it is, or is in his opinion in the nature of, a benevolent home, convalescent home, home for aged persons or rest home;
With the general purport of that provision I have no fault to find. Its effect is that full hospital benefits will go to patients in those institutions which are, in effect, hospitals and shall not go to those institutions which are, in effect, benevolent homes. The reason is quite clear. A hospital must provide a great deal of skilled service, and is therefore faced with expenses that are not incurred in a benevolent home. So the cost of running such a hospital is much higher than the cost of running a benevolent home, and the higher benefit should therefore go to the hospital.
However, I am rather doubtful whether the Director-General should be the final arbiter in this matter. What criteria is he going to apply? I suggest that the kinds of criteria he would use would be these: Where there is consistent medical attention such as injections and dressing of wounds and use of drainage tubes, &c, you have medical attention of the kind associated with a hospital. Again, where patients are bed-ridden you have circumstances that are familiar in hospitals. These are the kinds of criteria which I presume the Director-General would use in coming to the conclusion that an institution ought to be recognized as, in effect, a hospital, so that patients may receive the full hospital benefit. I feel, however, that there should be provision for an appeal to the Ministry in those cases where applications for benefit are rejected. It is most important that those whose applications are rejected should feel that they have the right of appeal, that these matters are sorted out, that the criteria are applied, so that if ultimately their applications are again rejected they may come away satisfied that justice has been done. Inclusion of a provision for the right of appeal to the Minister ought not to overburden the Minister, because the number of institutions involved would not be large.
I turn now to the provisions regarding pharmaceutical benefits. The present high and growing cost of pharmaceutical benefits has brought about the Government’s present proposals regarding them. Will the proposals in this bill serve the purpose that is intended? Why has there been this great increase in the cost of providing pharmaceutical services? First of all, there has, of course, been the invention of quite a large number of new and expensive drugs. Secondly, people are living longer and enjoying the benefit of less ill health. Thirdly, there is the problem of wasteful prescribing.
Wasteful prescribing may take one of two forms - either an expensive drug is prescribed when a less expensive one would do, or too great a quantity is prescribed and a large part of it is wasted. Now, I ask again: Is the proposed remedy likely to be successful? Will it really impose a brake on wasteful prescribing? I doubt very much whether it will, because when the list of drugs which will be available under the scheme is greatly extended there will be imported into the whole scheme the possibility of a much greater wastage, in a secondary sense, with the prescription of the greater quantities of drugs.
Now, as regards prescribing cheaper drugs rather than the more expensive ones, I think that the people, having become accustomed to the present scheme and the provision of the more expensive drugs, will put pressure on medical men to continue to prescribe the more expensive drugs, even if a cheaper one is available at a nominal charge of 5s.
I found myself greatly attracted to the proposal put forward by the right honorable member for Cowper (Sir Earle Page). There is nobody in this House with greater experience in those matters. If we were to institute a pharmaceutical insurance scheme the pharmacists, who come in close contact with the wastages in prescribing, and who are closer to the patients and perhaps know better what goes on, are likely to put pressure on the medical profession to ensure that prescriptions are not wasteful, because they will have an interest in making their insurance scheme pay. If this should not happen, then obviously the cost of drugs will become so high that the contributions that would be required from those who contribute to the pharmaceutical insurance scheme would also become so high that contributions would fall off, and the scheme would crash of its own weight. In those circumstances the pharmacists would suffer. It is important that we should have people who have an interest in keeping down the cost of the scheme bringing their influence to bear upon the medical profession in regard to prescriptions.
In conclusion, I would say that I am even more enamoured of the right honorable gentleman’s suggested scheme because, on referring to the report of the Hinchcliffe Committee on the Cost of Prescribing, published by Her Majesty’s Stationery Office in 1959, I find that that committee came to the conclusion that the charge for prescriptions in the United Kingdom has not served its purpose. The right honorable member for Cowper added that the increased charge that had been made recently there is still proving ineffective. So I suggest that the proclamation of the part of the bill dealing with the prescription charge be held up while the Minister explores with the pharmacists the possibility of their instituting an insurance scheme along the lines proposed by the right honorable member for Cowper, However, I do not wish to say anything that would derogate from my original support of the measure that the Minister has brought forward. I think that the rest of the bill is excellent. There is a doubt as to the wisdom of the proposal with regard to pharmacists. The bill in general will bring about a real improvement in the national health scheme which, as I said at the outset is, I believe, one that gives the best value for the money that the people pay for it. Having regard to the many claims on the public purse and the many purposes which must be served by this Parliament I think it is a reasonable contribution to the health of the nation.
– Mr. Speaker, the purpose of this bill is to bring our national health scheme up to date in respect of its three sections - medical, hospital and pharmaceutical benefits. There has been a very gratifying response by the public to the purely voluntary scheme which this Government introduced in respect of medical and hospital benefits. Two years ago, I was informed that 62 per cent of the population was covered by it. I understand that the proportion at the present time is 67 per cent. However, about 10 per cent, of our population is composed of pensioners, servicemen, and inmates of mental institutions and similar places. I think that it would be fair to suggest that another 10 per cent, of the people, probably, are unwilling to join in a scheme such as this. Therefore, more like 80 per cent, of those who could come within the scope of the scheme are probably covered. This indicates to me a very ready and very satisfactory acceptance of the principle of self-help and government assistance.
However, all along, there has been one very obvious defect in the medical benefits side of the national health scheme. The benefit refunded in respect of major surgical operations, the administration of anaesthetics, and investigatory operations and services has been quite inadequate. Only very minor changes in the benefits have been made since 1953, and there have been quite large increases in medical costs since that year. The refund of 12s. - in some instances, it may even be 13s. 6d. - in respect of each fee of 17s. 6d. charged for surgery consultations is quite adequate, and this benefit does not call for any change.
I understand that there is a move afoot to charge an additional 6d. a week by way of contributions in order to allow funds to increase this benefit, the fund to pay 10s. and the Commonwealth to pay 6s. I sincerely hope that this proposal will not be proceeded with. It seems to me that it would be an open invitation to the British Medical Association to increase the consulting fee to 25s. I hope we can prevent that. This move would mean, in addition to an unnecessary increase in contributions, that fund members would have to pay out of their own pockets more than they do now. It must be remembered, too, that there is a limit to the weekly subscriptions that people can afford to pay. If these subscriptions get above the economic level in relation to the daily life of fund members, we face loss of fund membership and the breaking down of the whole scheme. I suggest that once these subscriptions reach 6s. or 7s. a week we have gone as far as it is possible to go.
More than 11,000,000 of the 15,000,000 services provided under this scheme in 1957 came under the heading of benefits in respect of consultations with general practitioners. I have not the actual figures for later years, but I understand that there has been no change in the very large percentage of the total that this class of claims represents - about 74 per cent. It appears to me that the normal family requirements in respect of visits to the family doctor are quite adequately covered. But the benefit paid in respect of what may be regarded as a catastrophe - the Commonwealth benefit is no more than £11 5s. for a major operation or £3 15s. for a normal confinement - is quite inadequate. The Government has now decided to increase the benefits it pays and thereby bring the total benefit nearer to reality. Fund benefits, too, will be very materially increased. If some of the funds have to increase their contributions by as much as 6d. a week, that will be unfortunate.
The new rates of benefit announced in respect of some 140 items under this bill have been arrived at, evidently, after consultation with the British Medical Association and by agreement with it. The Minister for Health (Dr. Donald Cameron) indicated that the Commonwealth benefit for major operations will be increased from £11 5s. to £22 10s. and that the benefits in respect of some less serious operations will be appropriately increased. I have carefully looked through the list of proposed increases, and I find that for only seventeen of the 73 items in respect of which the present benefit of £11 5s. is being increased is the benefit actually to be doubled. The increased rates in respect of the remainder of these 73 items range from £15 to £18 15s. The benefits in respect of 59 of the items at present subject to a benefit of £11 5s. are not being increased at all. It would be interesting to know why these items were regarded as meriting the maximum benefit when the scheme was introduced and are not so regarded now. I hope that the Minister has these items, also, under review and that the benefits in respect of them will be increased as soon as possible.
The figures indicate that approximately 50 per cent. of the money expended on this scheme is spent on the payment of benefit for the first item - consultations with general practitioners. A reasonable objective, if we are to make this scheme attractive to the public and maintain its present coverage, or possibly increase the coverage to more than 80 per cent. of those who could benefit, would be for the Commonwealth to double the whole range of its benefits for operations. This would probably involve an additional cost of £4,000,000, and perhaps even up to £5,000,000, but it would bring the scheme much closer to satisfying the claim made by the right honorable member for Cowper (Sir Earle Page), when introducing the national health scheme, that it was intended to meet the costs of 90 per cent. of medical services for all those who were willing to come into it.
The proposed alteration of hospital benefits does not concern me greatly. Since the inauguration of this scheme, the Government has very substantially increased the benefits which it provides, and the present amendment in this respect is really only to re-define the conditions attaching to the special account procedures. I take it that this means that the patients in homes which are not recognized under the act as hospitals will be entitled to benefit if they are suffering from any illness or injury requiring treatment of the kind usually associated with public hospitals, provided that the treatment conforms to the standard of that given in public hospitals. I believe that all honorable members will be in accord with this.
However, I find cause for concern over the proposed drastic changes in pharmaceutical benefits. The Minister has told us that the cost of these benefits has risen so high that it must be controlled if it is not to dominate our national health service and leave correspondingly less room for improvements in other benefits. He said, also, that the national health service is not something that is static and fixed, that it does not need to remain in the form in which it began, and that it must be capable of modification and improvement from time to time as circumstances demand. He said that these modifications and improvements must be made in a way which is financially responsible and properly correlated to the rest of the great structure of social services which the Government has built up. He also spoke, at the beginning of his speech, of the benefits flowing directly to patients. He stated -
There is no doubt whatsoever that a contributory health benefits scheme on a voluntary basis is the one most appropriate to Australian needs and conditions and that the future of this scheme is now assured.
With this I could not agree more. But why did the Minister not remain consistent in his thinking and apply this same contributory idea on a voluntary basis to the pharmaceutical benefits as well as to medical and hospital benefits? I was delighted to hear the honorable member for Cowper (Sir Earle Page) advise the Minister that we should adopt this procedure. All honorable members who have not done so should study that speech most carefully. Several other members also have brought this proposal forward and I want to associate myself closely with it.
I compliment the Minister on his patience in sitting through the whole of this debate. He has set a precedent for other Ministers to follow when bills concerning their departments are under consideration. He has taken terrific punishment and I warmly congratulate him on having sat through to this very late hour listening to members putting forward their ideas. But as it is such a late hour I would like to suggest to you, Mr. Speaker, that perhaps the Minister would consider this a suitable time to adjourn the debate. I ask for leave to continue my remarks at a later date.
Leave granted; debate adjourned.
Thursday, 12 November 1959
Motion (by Mr. Downer) proposed -
That the House do now adjourn.
.- I should like to refer to a matter concerning the resumption of many homes in the Redfern district which is in the Watson electorate. It is the intention of the Department of the Interior in the very near future to issue notices to approximately 50 tenants to vacate their homes by February, 1960, for the purpose of erecting a mail sorting branch for the Postmaster-General’s Department. This will result in over 200 people, including some pensioners, being thrown out of their homes. I have been in touch with the New South Wales Minister for Housing, Mr. Landa, and the State member for Redfern, Mr. Fred Green, regarding the provision of alternative housing for the people affected. Those two gentlemen have informed me that, as this is a Commonwealth resumption of considerable magnitude with a large number of people involved, the New South Wales Government and the New South Wales Housing Commission firmly believe that the Commonwealth Government should make a special allocation of loan money available to provide the alternative housing.
I agree with and entirely support the view expressed by the New South Wales Government, bearing in mind that over 28,000 applicants for homes are registered with the New South Wales housing authorities. To expect the New South Wales Government to provide the money required out of its present inadequate housing allocation is grossly unfair and unjust, particularly to many of the 28,000 applicants who have been waiting many years for homes and are still waiting. I suggested to the PostmasterGeneral (Mr. Davidson) some time ago that the Commonwealth Government should make the necessary loan money available. T!”e Postmaster-General seemed very sympathetic to my view but he said that it was a matter for Cabinet to decide.
I received no concrete answer, with the result that I spoke to the Prime Minister (Mr. Menzies) a few weeks ago and he promised to look into the matter. Subsequently, I received correspondence from the Prime Minister’s Department, signed by the Minister for Immigration (Mr. Downer) for the Prime Minister. The substance of that correspondence reveals a final and conclusive decision. The relevant portion of the correspondence reads as follows: -
When the Commonwealth resumed ownership of the properties on the site it was explained to the tenants that the land would be required eventually for Commonwealth purposes and occupancy of the buildings was placed on a weekly tenancy basis to encourage tenants to find alternative accommodation. It is now proposed to issue “Notices to Quit” to the present tenants in order to obtain vacant possession by early 1960 when construction of the new buildings is due to commence.
The problem of re-housing the present tenants is regarded by the Commonwealth as being a State Government responsibility and this was explained at a recent conference between the Commonwealth Minister of National Development and the Postmaster-General and the State Minister for Housing. The New South Wales Government has been kept well informed over the years as to the Commonwealth’s intention to build a Mail Exchange building at Redfern, and as the tenants in the buildings on the site have been aware of the temporary nature of their tenancy the Commonwealth feels that it cannot accept the responsibility for finding alternative accommodation for the present occupants. I understand that efforts are being made to make accommodation available through the New South Wales Housing Commission so that vacant possession of the buildings in question will be available to allow construction work to commence as planned in early 1960.
I do not dispute the claim that the tenants were notified that eventually their homes would be required to make way for the mail sorting branch. A few of the tenants were lucky enough to find other accommodation and have moved from their homes. Since then, those homes have been demolished. Perhaps some honorable members wonder why the Housing Commission has not done something to find these people homes. The position is this: When a person makes application to the Housing Commission, an officer of the department visits the applicant’s residence to make an inspection. If the officer is satisfied that the premises are suitable to the applicant’s needs the applicant is then given a file number which gives him very little chance of obtaining a home unless he is evicted by a court order. That is due to the priority given to urgent cases such as families living in overcrowded homes or single rooms.
Another very serious problem emerges from this resumption. I refer to the pensioners involved. Due to this Government’s 1956 housing agreement which abolished the rebate system, pensioners, if allotted Housing Commission homes would have to pay £4 a week or more in rent, which I am sure honorable members will agree is beyond their means.
One would imagine that the Commonwealth Government would be giving something away if it made money for rehousing available. That is not so because it receives 4 per cent, interest on loan moneys made available to State authorities. The Commonwealth Public Works Committee’s recommendation on this matter reads as follows: -
Progress of this important project will be greatly facilitated if the Commonwealth Government lends its influence to those authorities in a position to take action to supply alternative accommodation for the people to be displaced from their homes on the site.
I would also like to quote what the Liberal Leader of the Opposition in New South Wales said on this matter.
– What is his name?
– His name is Askin, and he said -
It seems now that there is a stalemate between the Commonwealth and State Governments as to who is responsible for re-housing them. Housing is primarily a State Government matter, but where such a large number of houses and people are affected I think the Commonwealth Government might reasonably be expected to co-operate with the State Government in finding a satisfactory solution.
– Who said that?
- Mr. Askin, the Liberal Leader of the Opposition in the New South Wales Parliament. I venture to suggest that if a similar Commonwealth resumption of homes were necessary in a swing seat occupied by a Government supporter, there would be no hesitation in making a special allocation available. But, of course, the working people and pensioners of Redfern are of no importance to this Government. It seems strange that there is no restriction on the amount of money spent by this Government on renovating, re-modelling, re-furnishing and maintaining palatial homes used by V.I.P.s and owned by the Commonwealth, such as Admiralty House or Kirribilli House, or on Ministers’ suites and bathrooms in hotels, or on suites for former Prime Ministers.
Finally, this Government stands condemned in the eyes of all humane people for not making this money available to the New South Wales Government.
– Mr. Speaker-
– What will the Minister have to say about this?
– The honorable member will hear me say it for ten minutes. The matter referred to by the honorable member for Watson (Mr. Cope) has been under consideration for a number of years. At no time during those years has there been any acceptance by the Commonwealth of the responsibility which the honorable member for Watson suggests it should assume, and which the New South Wales Government has recently suggested it should assume. As a matter of fact, it would appear that New South Wales is attempting to use the special circumstances of this case as a lever to obtain extra finance from the Commonwealth for normal housing purposes.
Let us look at the facts of this case. It arises from the necessity for the department to provide more suitable mailhandling facilities in Sydney - the need for which is becoming more and more urgent. The matter has now reached the stage where the move to provide those facilities must be commenced as soon as possible. From time to time pressure has been brought to bear by honorable members opposite, on behalf of the unions concerned, to ensure that better working facilities are provided. The move commenced in 1949, during the regime of the Chifley Government. I point out that everybody concerned in this matter has been thoroughly aware from that time of the department’s plans. The New South Wales Government has had-adequate warning that it would need to provide alternate accommodation for those whom this proposal would dispossess. It is interesting, in view of the comments made by the honorable member for Watson, to note that there is on the file a memorandum prepared bv the Postmaster-General in the Chifley Government in 1949, in which it is stated, amongst other things -
It should not be necessary to displace the tenants for at least three years, by which time-
Honorable members will note this - the State Housing Commission expects to have better-class accommodation available.
That is a clear acceptance by a Minister of the previous Government of the fact that the State Housing Commission would be required to provide this accommodation. It expected to have the accommodation available by about 1952.
To continue with the survey of the position, I point out that the present Government moved to acquire the site in 1951. In 1952, following that acquisition, discussions took place regarding housing between the State authorities and the then PostmasterGeneral, who advised the State authorities that construction would be delayed for at least two or three years so that adequate time could be provided for the State to find the necessary housing. Therefore, it will be seen that the State Government has had at least seven or eight years’ warning of its requirements in this matter. The contention that people are being dispossessed as a result of the Commonwealth’s action and that the Commonwealth has a responsibility, which does not exist in any other case, to provide housing will not hold water. The tenants of the premises in question were warned on acquisition - that is, in 1951 and 1952 - that the site would be required for Commonwealth purposes, and that as the existing tenancies expired they would be renewed only on a weekly basis. They have been on that basis ever since. Further certain claims were made by some occupants for compensation. Those claims have been dealt with and satisfied, an amount of more than £130,000 having been paid in compensation. If that does not constitute adequate warning to all concerned, I do not know what does.
The honorable member for Watson will remember that he and I visited the area at least eighteen months ago. Walking around the site with the honorable member, I found that all the tenants were fully aware, even then, that they would have to vacate the premises and find other accommodation. So the tenants have been fully aware of the position. If no move has been made by those responsible for providing accommodation, I cannot accept the blame on behalf of the department or the Commonwealth Government.
The Government can wait no longer to set out to provide these postal facilities. I remind the House that some time last year the Public Works Committee investigated this proposal. That investigation was open to the public. The results of the committee’s investigation were notified to this House and published in the press.
Finally, the House adopted this Redfern proposal. Following that, there was correspondence between the Commonwealth Government and the State Government, finally on a Prime Minister to Premier basis, with the result that a conference was held between the Commonwealth Minister responsible for housing, myself and the New South Wales Minister for Housing. That conference is referred to in the Prime Minister’s letter which was read by the honorable member for Watson. The object of the conference was formally and finally to advise the New South Wales Government of the Commonwealth Government’s intention to proceed with the new building. In addition, the New South Wales Minister for Housing was warned by me of the Government’s intention to issue notices to quit to the present tenants, such notices to take effect as from next February. He was informed that we would require vacant possession of the premises by June, 1960. It was made very plain to the Minister that even under that programme we would not be in a position to complete the building and have it ready for operation at least until some time in 1964, and that, therefore, the matter was one of urgency.
It is correct that at that conference Mr. Landa, the New South Wales Minister for Housing, submitted a proposal that the Commonwealth should provide some funds to enable the State to go ahead with the provision of extra housing, but it must be clearly stated that the Commonwealth Minister responsible for housing accepted no obligation whatsoever on behalf of the Commonwealth Government to provide such finance.
I wish to make it clear that this new mail exchange, quite apart from being essential to the department, will be of major importance to the City of Sydney. It will cost more than £4,000,000.
– We do not dispute that for a minute.
– It will provide a great deal of employment over a period of about four years. A tremendous quantity of materials will be required for its erection. It will be of great value to the building industry in New South Wales. It will provide vastly improved conditions for the workers in the department. It will make a material contribution to a solution of the traffic problems of Sydney, because Pitt-street and the other streets adjacent to the present G.P.O. are already overcrowded and require a great deal of relief. By this proposal the department will be doing much to ease what is at present a great traffic problem to the State. In view of the value of the work to the State, I suggest it is only fair that the State now should bear its share of providing this building, that share being the provision of the necessary accommodation.
Order! The Minister’s time has expired.
– I wish to bring to the notice of the House the effect which the importation of what is known as ready-made rattan furniture is having upon the Australian manufacturing industry. Some weeks ago I received a deputation from this industry, and I have also received representations from the union concerned. As the result of the importation of this ready-made rattan furniture the Australian manufacturing industry is facing complete collapse, and a demand is being made upon the Government to take urgent action to avert such a happening. I am keenly interested in this matter because this industry, which employed 475 people before the war, is reduced to such a state that it now employs only 60. In the area of Leichhardt there are nine small manufacturers operating, some of whom have been in business for 50 years and others for 30 years. Where once they employed 30, 25 and eighteen men, to-day some of them are employing only one man. The nine firms operating in Leichhardt employed 138 men, an average of sixteen employees each, three or four years ago. To-day, they employ a total of 32, or fewer than four each.
The base material used in the manufacture of this furniture is cane that is procured in Indonesia. It is controlled by a monopoly of overseas interests. After being purchased in Indonesia, the cane is shipped to either Japan, China or Hong Kong where it is made into ready-made furniture and exported to Australia. The retail cane trade is enjoying a boom in Australia, but the Australian manufacturers and their em ployees are not sharing in that boom. This trade has become a monopoly of overseas interests.
There are two important aspects that require investigation by the Government. The first is that overseas interests are setting themselves up in business here to the detriment of Australian manufacturers. Nobody objects to overseas interests establishing themselves in Australia so long as they do not do so to the detriment of Australian industries. The figures I have quoted show, however, that without protection from the Government, the Australian industry has suffered severely. It is in dire straits and cannot stand up to the competition it is meeting from these overseas interests which are setting themselves up in the capital cities. I know for a fact that two or three of them’ set themselves up in business in Sydney recently with disastrous results to the local manufacturers.
The other aspect is that the Australian retail houses are now importing this particular commodity direct. One Australian manufacturer who was accustomed to receiving an order worth £6,000 a year from one large retail house in Sydney was told by that retail house a few months ago that it would have no further business for him, that in future it would be importing the furniture direct. I should like to know how it is that this retail house is getting a licence to import this furniture when the Minister for Trade (Mr. McEwen) has said on many occasions that certain regulations and conditions govern the issue of import licences.
The overseas interests to which I have referred have also been guilty of very questionable practices. The representative of one of them called upon a local manufacturer some time ago, inspected his factory, obtained brochures and price lists from him and then departed, leaving the local manufacturer with the impression that he would be receiving a large order. Instead, the overseas interests imported the furniture direct from Hong Kong. They flooded the Australian market. I put it to the House that no industry can stand up to practices such as that. An Australian industry which once employed 500 men is now employing only 60. These Australian employers have always given their employees decent wages and conditions and they are now suffering at the hands of overseas interests who are importing from Hong Kong furniture manufactured by labour for which the wage rate is 2s. a day. The local manufacturers have impressed upon me that it is urgent that the Government take action to protect them, otherwise they will face complete extinction. I sincerely hope that the Government will take the action necessary to protect the industry from that fate.
.I support the remarks of the honorable member for Dalley (Mr. O’Connor). As an indication of what is happening to the Australian industry, I point out that one manufacturer in my electorate who had 30 employees only two or three years ago is now employing only four men. He has altered his premises and finds that he can earn more from letting them than he can from manufacturing this furniture. As a good Australian employer who is grateful to his good Australian employees, he cannot bring himself to dismiss the four remaining employees. They are dependent upon him for a living, for they do not know any other trade or vocation. At the moment, this man is trying to carry on in the hope that he will get that relief to which he feels he is justly entitled.
Honorable members might ask why these manufacturers do not get together and present a case to the Commonwealth Government. It is not so easy for them to do that. I pointed out on a previous occasion that the organization is comprised of retailers and manufacturers, and trying to get them together is like getting a lamb to lie down with a lion; it just cannot be done. Some retail stores are not greatly concerned where the furniture they sell comes from. They are interested only in selling. Furthermore, they are importing thousands of light cane chairs from Hong Kong. The construction of these chairs is very flimsy, but the average person who buys cane furniture does not know enough about it to know whether its construction is strong or flimsy. The result is that frequently the flimsilyconstructed furniture is brought back to the Australian manufacturer for repair. The manufacturer of whom I am speaking has a display window and showroom and he always keeps a couple of the Chinese manufactured articles alongside his own. He demonstrates a practical example in front of the customer, and the comparison is most favorable to the Australian chair although the price is quite a bit higher. But the customer realizes that it is still much more worthwhile to pay the extra for the Australian chair because of its better construction. Unless other retailers are prepared to follow the example of this manufacturer and retailer, the Australian purchasing public will not have a chance of knowing which is the better article or that they will get better value by paying a little more for the Australian chair. The difference is quite easy to see when it is pointed out. The Chinese chairs of which I have been speaking look quite good. They have been nicely painted and it is not until one examines them closely that one realizes that the Australian article, though dearer, is the better investment.
On a previous; occasion I have said that there are merchants in Hong Kong who are most unscrupulous and ruthless in their attitude towards the Australian industry. It is a small industry and does not number its employees in tens of thousands as large industries do. It has only a couple of thousand employees throughout Australia, but they are making a most important contribution to the furniture trade. The merchants in Hong Kong, because of their control of raw material such as cane, are able continually to raise the price. When they see the Australian manufacturer cutting his; costs to the bone and even deeper, they raise the price of raw material and as a consequence he cannot compete with them.
I do not know whether it is possible for the Minister for Trade (Mr. McEwen) to rectify this position without waiting for a long Tariff Board inquiry to be made. I have examined Tariff Board reports and I am aware that the board goes deeply into the roots of any problem referred to it. But I am also keenly aware that sometimes these investigations take six to twelve months. If that should happen in this case, what remained of this Australian industry would have become extinct by the time the report was presented.
I now want to deal with the attitude o! the big retail stores which are importing these chairs directly from Hong Kong. It is possible, by stacking chair inside chair, to load a large number of them into a small space. The Chinese people, being extremely ingenious, are taking advantage of that fact and they have exported large numbers of chairs in this way. When they arrive in Australia they are assembled and placed on display. The retail stores do not care where they come from so long as they can make their profits. Sales of these particular chairs are soaring. The salesman in a store will not bother to point out to the Australian customer that although the Australian chair is dearer in price it is a better article and worth more than the Chinese chair. He is concerned only with making a sale.
As a result of this action by the large stores many employees in this industry have lost their jobs. Some of them have spent a lifetime in this trade and they do not know where to look for another job. Many of them are in their fifties and they are finding it exceedingly difficult to get employment. If any honorable member wants to find out how hard it is to get a job in the only trade that he knows let him try to get one after he has turned fifty.
It is high time that the Government took this matter up without waiting for any further representation from the furniture manufacturers. The Australian Industries Preservation Act could be invoked and licences for the importation of these articles could be cancelled. If the Minister would only see a deputation from these people, it could be arranged very swiftly and its members would put the facts before him in black and white, plain for himself and everybody to see. They would show that there is a strong case for immediate action to preserve this valuable Australian industry.
Mr. WARD (East Sydney) [12.35 a.m.l. - We have heard an extraordinary speech from the Postmaster-General (Mr. Davidson). But it was not an unexpected one because it was consistent with the Government’s callous disregard of the problems of the ordinary person in the street. The honorable member for Watson (Mr. Cope) is to be commended for raising this matter of the threatened eviction of between 200 and 250 people, including pensioners and children, from their homes in order, as the Minister said, to provide urgently required postal facilities.
Neither the union nor members of the Opposition, including the honorable member for Watson, have ever contended that this new building should not be erected. What the honorable member said, quite rightly, was that, whatever government authority is responsible, whether State or Federal, it should be prepared to make some provision for these people. If it is an argument between the State and the Commonwealth, the answer is that every one is aware of the State’s difficultites. It has not the money with which to provide alternative housing for these people and unless the Commonwealth provides it, they will be emptied out onto the street. Those affected, as I have said, include not merely men and women, but children and pensioners as well.
The Minister said that this is a move by the State Government to bring pressure to bear on the Commonwealth to get additional finance for housing. If the State has not money to provide housing for the displaced people, to whom else can it look but to the Commonwealth? The Commonwealth should provide housing for them.
The Minister seems to think that the situation is met fully and completely by his statement. He said all the parties concerned were completely aware of the situation and that the tenants were warned some years ago. But what is the use of giving these unfortunate people warning of what is going to happen to them if they cannot do anything about it? The Housing Commission of New South Wales has had applicants on its books for up to ten years.
Not long ago the Commonwealth Minister for National Development (Senator Spooner) declared that the solution of the housing problem was within sight. If the original timetable he laid down had been adhered to, according to him the housing problem would have long ceased to exist.
The Postmaster-General produced a file containing a statement which he thought would be a major hit. He said that there was a record, dated 1949 which showed that the then Labour Postmaster-General, had declared that within three years it would be necessary to displace the tenants and that he expected the New South Wales Housing Commission to make arrangements for alternative housing. But what the Minister failed to appreciate was that in 1949, when
Labour was the Government it did not envisage defeat at the forthcoming general election. It thought that there would be a Labour government in control in 1952. If there had been a Commonwealth Labour government in that year these people would have been provided for and the finance would have been provided for the State. Consequently, the Postmaster-General’s defence is a very paltry one.
What does he mean when he says that compensation of about £130,000 has been paid? I am speaking from memory when I give that figure. He did not say that the compensation was paid to the displaced tenant. It was paid to the property owners, the people whose properties will be acquired in order to make way for the provision of these postal facilities. But the unfortunate person who is renting a room or a home will go out without any compensation at all from the Government! He will receive no compensation for the disturbance of his home. The unfortunates who are being turned out will be asked to pay higher rents because anybody knows that in the newer areas rents for homes are higher than for those in the older parts of inner Sydney. No provision is being made to compensate these 200 or 250 people.
The Minister seems to think he has a complete answer by saying that the new building will provide better working facilities for the postal employees. We admit that. The union recognizes that, but it also recognizes the difficulties of the people who are going to be displaced to make way for this additional accommodation for the Postal Department. The union is supporting the honorable member for Watson in his campaign and his request that the Commonwealth Government do something to provide for these unfortunate people.
I say frankly to the Minister that he has a complete and callous disregard for the difficulties and the problem of these people whom the Government is displacing. It is not sufficient to say that they were warned and given notice. What they must get is assistance from either the State or the Commonwealth to provide them with alternative housing. The State cannot do that, because it has not the necessary finance. Therefore, the obligation is directly on the Commonwealth Government. It is the Commonwealth’s building.
The Commonwealth has acquired the property; it is going to displace the tenants, and it is causing the people to be put on the streets. Therefore, it is to the Commonwealth Government that we look for provision to be made for them.
Question resolved in the affirmative.
House adjourned at 12.41 a.m. (Thursday).
The following answers to questions were circulated: -
i asked the Minister representing the Minister for Civil Aviation, upon notice: -
– The Minister for Civil Aviation has replied as follows: -
y asked the Minister representing the Minister for Civil Aviation, upon notice -
– The Minister for Civil Aviation has furnished the following replies: -
m asked the Minister for Labour and National Service, upon notice -
– The answers to the honorable member’s questions are as follows: -
Convention No. 110 concerning Conditions of Employment of Plantation Workers - Abstained.
Recommendation No. 110 concerning Conditions of Employment of Plantation Workers - Supported.
Convention No.1l1 concerning Discrimination in Respect of Employment and Occupation - Abstained.
Recommendation No.111 concerning Discrimination in Respect of Employment and Occupation - Supported. 43rd (1959) Session-
Convention No. 112 concerning the Mini mum Age for Admission to Employment as Fishermen - Abstained.
Convention No. 113 concerning the Medical Examination of Fishermen - Abstained.
Convention No. 114 concerning Fishermen’s Articles of Agreement - Abstained.
Recommendation No.112 concerning Occupational Health Services in Places of Employment - Supported.
a asked the Postmaster-General upon notice -
What was thelabour turnover in the (a) postal, (b) telephone and (c) telegraph sections of his department during each of the years 1957-58 and 1958-59?
– The answer to the honorable member’s question is as follows -
The labour turnover for the years 1957-58 and 1958-59 was as follows: -
Postal (i) Post Offices Branch- 2,809 and 2,532; (ii) Mail Exchange Branch - 1,187 and 1,240. (b) Telephone Service Branch- 3,067 and 3,166; (c) Telegraph Service Branch - 370 and 377.
These figures correspond to -
(i) 18.1 per cent. and 16.1 per cent.; (ii) 19.7 per cent. and 20.0 per cent.; (b) 27.3 per cent. and 28.5 per cent.; (c) 13.3 per cent. and 14.1 per cent. of the average staff employed in the respective branches during the years concerned. They comprise the staff who left the department during the respective years and include those who died, resigned or were retired through age or because of illness, but do not include staff engaged specifically for short periods to meet seasonal requirements or to provide recreation and sick leave relief. The higher turnover in the Telephone Service Branch is due to the number of telephonists who resigned to get married.
a asked the Postmaster-General, upon notice -
Will he supply particulars of plans for the erection of a new post office at Padstow, New South Wales?
– The answer to the honorable member’s question is as follows -
The project is included in a schedule of works awaiting attention, but due to the need to first proceed with a large number of more urgent projects, construction of the new post office at Padstow is unlikely to proceed within the next two or three years.
k asked the acting Minister for the Interior, upon notice -
– The answers to the honorable member’s questions are as follows: -
t. - On 22nd September, the honorable member for Hughes (Mr. L. R. Johnson) asked the acting Treasurer a question without notice relating to the hire-purchase activities of the Industrial Finance Department of the Commonwealth Bank. The honorable member referred to the fairly static volume of such activities over recent years, and suggested that the Industrial Finance Department should go out after more hire-purchase business in competition with other hire-purchase agencies. I now furnish the honorable member with the following answer: -
The outstanding hire-purchase balances of the Industrial Finance Department as at 30th June over the past eight years were as follows: -
With regard to the department’s hire-purchase activities during 1958-59, retail hire-purchase transactions financed by the department in that year totalled 13,347 for £14,100,000 (excluding hiring charges) compared with 12,502 transactions for £13,000,000 in the previous year. In addition, the department continued during 1958-59 to make available, on a limited scale, wholesale-finance to machinery merchants and dealers for the holding of goods pending sale.
In accordance with the purposes for which the department was established, the hire-purchase activities of the Industrial Finance Department from its commencement in 1946 have for the most part been limited to the provision of hire-purchase facilities for the acquisition of producer-type goods and equipment. The department has never provided hire-purchase facilities for the acquisition of domestic-type goods such as furniture, refrigerators, washing machines, radios, &c., and therefore has never competed with hire-purchase companies in this field. It is considered that the resources of the department, and of the Commonwealth Development Bank which is to take over the business of the department, are best employed in the provision of assistance for industry rather than for the acquisition of consumer-type goods. It has also to be borne in mind that the provision by the department of financial assistance to indus trial undertakings is not limited to the provision of hire-purchase facilities for the acquisition of producer-type goods and equipment. The department also provides assistance to a substantial extent by way of loans, and its ability to continue to provide such assistance would naturally be affected if it were to devote a greater proportion of its resources to hire-purchase business.
e asked the Minister for Health, upon notice -
– The answers to the honorable member’s questions are as follows: -
Cite as: Australia, House of Representatives, Debates, 11 November 1959, viewed 22 October 2017, <http://historichansard.net/hofreps/1959/19591111_reps_23_hor25/>.