17th Parliament · 1st Session
The President (Senator the Hon. Gordon Brown) took the chair at 3 p.m., and read prayers.
page 780
Supplies for Great Britain
– Will the Minister for Trade and Customs inform the Senate whether his attention has been drawn to a statement in the Melbourne press that the Lord Mayor of Melbourne intends calling a public meeting to discuss the need for approving additional food rationing in Australia to give further help to the people of Great Britain? If so, will he advise the Lord Mayor of Melbourne and the Premier of Victoria, who is aiding and abetting this political campaign, that they are rendering a grave disservice to the people of Great Britain by attempting to create the impression that Australia has not done, and is not doing, everything possible to help them in their difficulties?
– I rise to order.I ask Mr. President if the honorable senator is asking a question or making a political speech?
– I understand that the honorable senator is addressing a question to the Minister.
– Will the Minister also advise the representatives of the Government of Great Britain in Australia that certain anti-Labour interests in this country are trying to use them in this proposed campaign, the real purpose of which is to discredit the present Government in its efforts to help the people of Great Britain? Will the Minister tell the Premier of Victoria that he would be much better employed in planning to prevent bushfires in Victoria, and leaving national and international affairs to those on whom the responsibility rests - the members of the Commonwealth Parliament?
– My attention has been drawn to the proposal by, the Lord Mayor of Melbourne. In view of the fact that additional food rationing is a matter of government policy, I shall make a statement on the subject later.
– Has the Minister read a statement in the press to the effect that Canada has decided for the time being to abolish meat rationing owing to the large accumulation in that dominion of meat which, it is said, awaits shipment to the United Kingdom? Will the Minister, in making his statement later, clear up the doubt as to whether meat rationing in Australia is likely to be affected by the position in. Canada as reported in the press?
– Owing to the shortage of shipping in Canada some congestion has occurred with regard to the removal of meat to Great Britain. That is a further reason why meat rationing was introduced in Australia, and under present conditions it will be even more necessary than previously to ration our supplies. A similar congestion threatened Australia shortly before the introduction of meat rationing, but steps were taken to ensure an adequate supply of ships from Great Britain and the scheme was implemented.
page 780
asked the Leader of the Senate, upon notice -
Will the Government give consideration to amending the Motor Vehicles Agreement Act 1940 in order that our American Allies shall have equal opportunity to compete in the manufacture of motor vehicles?
– As it is not the practice to answer questions on matters relating to government policy, it is regretted that the desired information cannot be made available to the honorable senator.
page 780
asked the Leader of theSenate, upon notice -
– The answers to the honorable senator’s questions are as follows : -
page 781
asked the Minister representing the Minister for the Army, upon notice -
– The Minister for the Army has supplied the following answer : -
Inquiries are being made, and a reply will be furnished to the honorable senator as soon as possible.
page 781
In committee: Consideration resumed from the 1st March (vide page 708).
Clause 7 -
The pharmaceutical benefits referred to in this act shall consist of -
materials and appliances (not being uncompounded medicines or medicinal compounds) the names of which are contained in a prescribed addendum to the Commonwealth Pharmaceutical Formulary.
Upon which Senator Wilson had moved by way of amendment -
That, after the word “Formulary” at the end of paragraph (b), the following words be added : - “ and
a cost not exceeding an amount to be prescribed of such other medicines as are prescribed by a medical practitioner “.
.- The Minister for Health (Senator Fraser) has said that the Government is not concerned about the cost of the benefits provided for in the bill. If thatbe so, why should medicines be restricted to the formulary? Surely it would be better to rely on the discretion of the medical practitioner as to the medicines and doses necessary for the care of the patient, rather than allow a committee sitting perhaps at Canberra to prescribe a formulary which may provide for most of the known medicines to-day, but in a week or a month or a year may be entirely out of date. It seems to me that the clause tends to make the medical profession entirely static, whereas, if the practitioner exercised his present discretion, a drug or medicine which he might prescribe to-day might not be the drug or medicine he would prescribe to-morrow. Medical science is continually advancing. It is only the medical practitioner who sees the body of the patient and is in a position to judge what medicine he requires. It wouldbe a retrograde step to leave the bill in its present form. If, however, the Government will accept the amendment, and leave the discretion with the medical practitioner, so that he may prescribe the medicine which he believes is necessary for the cure of the patient, the bill may prove of some benefit to the community. My amendment places no restriction upon the prescription which the medical practitioner may issue, but it does place a limit upon the cost to be borne by the Treasury. What that proportion of the cost shall be, and what proportion of it the patient shall pay, is a matter to be prescribed after a thorough investigation of each case.
– Who would determine those matters?
– It will be a matter for determination by the committee which is to be set up under clauses 17 and 18. I should have no objection to including in this legislation a provision similar to that in the New Zealand act. That is to say, instead of the present clause 7, the following clause should be inserted -
For the purposes of this part of this act the expression “ pharmaceutical benefits “ means the right of every person entitled to claim such benefits to be supplied with all such medicines, drugs, prescribed materials, and prescribed appliances as are ordered for a person or for any member ofhis family by any medical practitioner in the course of pro- v iding any medical benefits or other benefits in accordance with this part of this act.
Under the New Zealand act the medical practitioner is entrusted with the prescription of the medicines that are needed for the cure of the patient, and, once he has prescribed the type and quantity of medicine to he used, the Treasury pays the bill. The New Zealand legislation is entirely without limit as to cost. It was only out of deference to some members of the Government and of the Opposition that I placed some limit on the cost to be borne by the Treasury. There is much to be said for their view that a blank cheque should not be given to any one, and that there should be some limit on the cost chargeable to the Treasury. In its present form my amendment provides that in respect of medicines that are prescribed and which are not in the formulnry, or in respect of drugs which are in the formulary but are prescribed in different doses, the Government will pay the prescribed portion of the cost, and the patient will pay the remainder of the cost. I urge the Government to accept the amendment, and to leave the prescription of the medicine to the medical practitioners who understand the job - men and women who have given at least five years of their lives to the study of medicine and have had practical experience in attending to the health, of the people. If the Government trusts the medical practitioners ofthis country as I trust them, there is no reason why it should not give to them the discretion to prescribe what medicines they consider necessary to maintain the health of the community.
– The more this clause is discussed the more confusing it becomes, and consequently the greater the difficulty in arriving at a decision regarding it. If the Minister could give an indication of the added cost of embodying in this bill a provision similar to that which is contained in the New Zealand act, we should be in a position to say whether or not we thought that the cost was too great. The whole question of costs will be determined on the basis of the formulary provided for or by the committee which is to be set up. If we accept the view of the Government that medicine shall be supplied free to those who need it, are we’ now to say that some of the medicines which may be necessary to safeguard the lives of the poor shall not be made available to them under this bill? That is a question which ought to be decided here and now. It would help considerably if the Minister were to give a reasonably well-founded estimate of the added cost involved in the New Zealand provision. It is not sufficient for him to say that the cost would be too great ; we should know on what grounds that view is advanced. The Minister is not in a position to indicate what the cost will be, because he does not know what drugs will be in- cluded in the formulary, nor does he know the degree to which the formulary maybe varied from time to time by the proposed committee. We should know more of the nature of the committee to be set up, and how and by whom its members will be chosen. We should know their qualifications to decide the important matters which will be entrusted to them. If our concern is to preserve the health of the people, the question of cost should not be a deciding factor; we should say that whatever is required in the way of medicines, drugs or appliances, shall be made available. If questions of cost are to decide what we shall do, then questions of cost may determine whether a patient shall live or die, because some of the cheaper medicines may not be suitable for the treatment of certain complaints. As the basic principle of this bill is the provision of medicine free of charge to the public I urge the Government to have nothing to do with half measures. Under this clause many people will not be able to obtain the assistance which they might be led to expect. I ask the Minister to give an estimate on a per capita basis of the cost of this scheme and that of the New Zealand scheme as it applies to the provision of medicine free of charge.
.- I support the view expressed by Senator Herbert Hays and Senator Wilson. The discovery of the new drug, penicillin, was announced only recently. In a case which was brought to my notice a few days ago, the life of a young mother was saved by the use of the drug which was made available to the woman’s medical adviser through the courtesy of the United States of America Army Medical Service. Tha:t drug and other new .drugs which have produced remarkable results are very costly, and I should like to know whether they will be made available free of charge under this scheme, if they are prescribed by a medical practitioner.
– I have already said that no approved drug will be excluded from the formulary because of its cost.
– I arn glad to have that assurance;; hut what guarantee have we that expensive drugs of the kind to which I have referred will be included in the formulary? It will be the duty of the formulary committee to decide what drug shall be added to the formulary from time to time. However, the bill contains no guarantee that expensive drugs will not be excluded from the formulary. As the Government has adopted the principle of making medicine available to the public free of charge, I fail to see why it cannot follow New Zealand’s example and stipulate that all drugs, regardless of cost, shall he provided free of charge if they are prescribed by medical practitioners. Therefore, I support the arguments advanced by Senator Herbert Hays and Senator Wilson concerning the appointment of a panel of doctors whose duty it will be to decide what drugs shall be added to the formulary. It is quite possible that this panel, which is to consist of three persons, may he quite out of touch with advanced thought in the medical profession. In addition, many medical men specialize in this work, and have evolved prescriptions in respect of which they practically possess the copyright. There is no guarantee under the bill that the formula which they would prescribe in norma] circumstances will be included in the formulary drawn up by the formulary committee. As the Government has adopted the principle that medicine shall bc provided free of charge it should remove all restrictions of the kind mentioned.
Senator SPICER (Victoria) F3.27].- I should like the Minister for Health (Senator Fraser) to explain fully the real purpose of the limitation contained in this clause. Cost has nothing to do with the matter. Under the bill, the formulary committee is free to include in the formulary any medicine and any drug. There is no limit to what the committee can put into the formulary. Should it see fit to put in every medicine which a doctor can prescribe, the Government will have to supply those medicines free of charge. Neither the Treasurer (Mr. Chifley) nor the Minister is to be consulted as to what shall he included in the formulary. Therefore, the limitation contained in this clause has no relation to the question of cost.
– The Minister said that.
– That is so; and, therefore, I should like to know the purpose of the limitation. Does the Government seriously believe that a panel of doctors, or chemists, sitting in Canberra, is likely to prescribe more appropriate medicine for an individual than the patient’s own medical practitioner? Surely, that cannot be the case. If the bill prescribes that the only medicines which can be provided are those that are prescribed by a doctor what other limitation is necessary? I could understand this clause if it indicated that only medicines costing up to 4s. for each prescription were to be provided free; but that is not so. The formulary committee will be free, if it deems fit, to include every medicine in the formulary, and neither the Treasurer nor the Minister will be consulted on that point. The Minister can hardly give an estimate of the cost of the scheme outlined in the bill because he does not know what medicines will be included in the formulary; and, therefore, he cannot give us an estimate of the cost involved in Senator Wilson’s amendment. The Minister should be able to indicate to the committee what the probable cost would be if it were possible for people to obtain any medicine which a doctor prescribed.
– The honorable senator means the total cost?
– Yes, and I should have thought that the first thing a responsible Minister would do before embarking on such a scheme was to ask, How much is this going to cost?”
SenatorFraser. - The honorable senator was absent from the chamber when I gave the figures.
– Then I ask the Minister to repeat them. The only estimate that I have heard is that of £4,000,000 a year mentioned by Senator Cooper.
SenatorFraser. - I told the committee that the estimate was £2,100,000.
SenatorSPICER.- Then it must be based on some assumed formulary. The Minister must be acting on the assumption that the formulary committee will restrict the formulas to certain medicines. What restrictions are to be imposed?
SenatorFraser. - I also told the committee that, but the honorable senator was not present.
– I have been present most of the time, and have heard most of what the Minister has said, but I have not found much information in it. I am seeking information now. It is obvious that the Minister cannot say that the scheme will cost £2,100,000 unless he knows what limitations are to be placed upon the formulas.
– An estimated cost of £2,100,000 would represent 2s. 3d. a prescription.
– On the assumption of 20,000,000 prescriptions mentioned by Senator Cooper, and assuming also that the formulary is very restricted.
– The 20,000,000 was an estimate of a medical committee.
– If we accept the figure of 20,000,000 prescriptions annually, we assume that all prescriptions are going to be covered by the formulary, but the Minister has not said that that is to be the case. I take it that there will be some restrictions, but those are not expressed in the bill. Will the Minister say what restrictions are envisaged and what drugs are not to be taken into account in the formulary? If he will do so, he will be able to show us how he arrives at the figure of £2,100,000. No person could arrive at that figure without knowing what is to be in the formulary.
Even if the Minister is acting upon the assumption that the formulary will be limited, there is nothing in the bill to provide that it shall be limited, and, as I understand it, the complete power to determine what is to be in the formulary will be left in the hands, not of the Minister or the Treasurer, but of the formulary committee. If the committee cares to include every known medicine, then obviously the cost will be greater than that envisaged by Senator Wilson’s amendment.
– The average cost of prescriptions in New Zealand is 3s. 9d. and not 2s. 3d. as stated by the Minister. That is on the basis that all alcohol for making up into prescriptions is duty free. I therefore suggest that Senator Cooper’s estimate of 4s. a prescription is very much nearer the mark than that stated by the Minister, unless, as Senator Spicer suggests, only cheap drugs are to be placed in the formulary. In other words, it is obvious from the Minister’s statement that the cost of the prescription has been estimated at 2s. 3d., and that the Australian public is to be doped with cheap drugs rather than supplied with good medicines necessary to effect cures. Penicillin, for instance, costs £4 a dose, yet the Minister says that the medicines which the Government intends to provide will cost only 2s. 3d. a prescription. It is perfectly clear that the Government does not intend to provide medicines which will cure, or help to cure, the sick and raise the standard of health of the Australian public, and that only trash and cheap dope, selected by a formulary committee, will be given out as free medicine for the purpose of appeasing the electors instead of improving the health of the community.
SenatorFRASER (Western Australia - Minister for Health and Minister for Social Services) [3.37]. - It is obvious to me that the Opposition thinks that any argument is better than none. When I gave previously, in Senator Spicer’s absence, the figures which he had sought, I added that the Government had entered into a contract with the chemists of Australia to supply medicines at 2s. 3d. a prescription. Because of the soundness of the case made by the
Government, the Opposition is making an attempt to heap ridicule upon it. In his second-reading speech, Senator A. J. McLachlan said a good deal about the cheap medicines referred to by Senator Wilson. The Government has not gone into this scheme by the method of pricking a card with a pin in order to find out what it can do or what the medical profession and the chemists can do. The matter has been thoroughly sifted, and I am pleased to announce, for Senator Spicer’s information, that,- with the aid of the experience of the United Kingdom and New Zealand, the Government has adopted a formulary. Senator Wilson talks about cheap medicines being included in it, but I assure him that the Army War Pharmacopoeia was the basis of the formulary accepted by the medical practitioners of Australia, amongst whom were some prominent members of the British Medical Association.
– They said that they would not agree.
– I know that they said that they would not agree, and I know what the New Zealand scheme is costing to-day because there is no formulary. I propose to give the committee as much information on “the question as I possibly can because it is evident from w>hat honorable senators opposite have said that they have not studied the provisions and scope of the bill. .Senator Wilson referred to the use in New Zealand of duty-free alcohol, his suggestion being that New Zealand could not possibly provide prescriptions at 3s. 9d. each unless the alcohol was duty free. I do not think for one moment that some modifications of the formulary will not be necessary after experience of the working of the scheme has been gained. I am sure that even honorable senators opposite could not draw up a scheme such as this without realizing that certain amendments might become necessary in the light of experience. That is so with all legislation. In framing this formulary, we have had the experience of both the British and New Zealand schemes to guide us. Reference to the British scheme has been made by several honorable senators opposite, and the suggestion has been made that we could well copy it in some respects. The fact is that that scheme and the New Zealand scheme have been examined thoroughly. We have been informed definitely - and the statement has been placed on record - that hospitals throughout Australia work to a formulary to the degree of 90 per cent. I draw ^attention also to the fact that an eminent Victorian medical authority has stated that 75 per cent, of the ailments suffered by the people of this country were of a minor character. Statements such as that from men of experience cannot be ignored. Obviously it is not the intention of the Government to appoint a blacksmith to the formulary committee. That committee will be composed of experts. I emphasize that no drug of proven value will be left out of the formulary because of cost. 1 should like that point to be understood thoroughly. Senator Foll mentioned penicillin. I hope that the time is not far distant when that valuable drug will be available not only to the fighting forces of this country but also to civilians, at cost price, and will be included in the formulary under this measure.
– Is the Minister serious when he says that penicillin at £4 a dose, will be included in the formulary ?
– Yes. I take the responsibility for saying that when sufficient quantities of penicillin become available it will be included in this formulary.
– Irrespective of cost?
– Yes. The alleged freedom of the doctor to prescribe under the National Insurance Scheme of Great Britain is, in fact, illusory, since it is completely controlled. The prescriber is empowered to use “ all proper and necessary drugs”, but a great many instructions are issued to the medical profession to ensure that due economy in prescribing is observed. If any doctor does not observe the rules, he is promptly dealt with. Approximately 900 doctors are interviewed in Great Britain each year in regard to alleged breaches of the instructions.
The formulary provided for in this measure will not be confined to the Army
War Pharmacopoeia,but will be an. extension of the Army War Pharmacopoeia as drugs which at present are in short supply, become available. One object of a formulary is to decide before and not after, the damage is done; All approved drugs willbe included in the formulary. The inclusion of drugs will be a matter for consideration by members of the medical profession and pharmaceutical chemists - not the Minister for Health or the Government. Do honorable senators opposite suggest that there is anyone more fitting for that difficult task?SenatorSpicer has argued that the formulary committee will be composed of only one or two members of the medical profession, but surely he does not suggest that the entire council of the British Medical Association should be on that committee? Speaking from memory, I think that Sir Henry Newland was chairman of the Army War Pharmacopoeia Committee, and I am sure that his integrity as a medical man will not be questioned by any one in this country. The Government has no intention of selecting for membership of the formulary committee any individual who has not had the widest possible experience. The formulary will be composed of probably 500 drugs.Senator Wilson’s object seems to be to try to overcome restrictions on doctors. Experience in other countries has shown that a blank cheque to doctors in their prescribing has its pitfalls. The need for control ‘is demonstrated by several inherent weaknesses present in the prevailing method of prescribing. First, there is the recourse by many medical practitioners to the hit-or-miss type of prescription, or, in. other words, the inclusion of several drugs in a prescription in the hope that, if one does not have the desired effect, one of the remaining ones will ; secondly, the unnecessary use of several drugs with similar therapeutic values in one prescription; thirdly, the use of complex compounds containing several ingredients that are not required by the patient, when simple drugs could be used with the same effect ; fourthly, the unnecessary use of many and various flavourings in one mixture; and fifthly, the use of standard formulas put up by different manufacturers under many names, sold at high prices, and urged upon the doctors by pressure methods of sale. About 38 per cent. of prescriptions written to-day, in which the doctors adhere to the formulas of the manufacturers, are for normal drugs and combinations which can and will be covered in the proposed Commonwealth formulary. These are all examples of unnecessary and wasteful prescribing for which, at present, the patient unwittingly pays. The use, in medicines, of flavouring ingredients of no therapeutic value has been admitted by medical men. I am not saying that that practice is right or wrong but the fact remains that the patient has to pay for those ingredients.
There is no doubt that in many cases to-day medical practitioners prescribe proprietary medicines. I shall not attempt to debate the question of the therapeutic value of such medicines; I am merely pointing out that that is being done. It will be for the formulary committee to decide whether these medicines should be included in the formulary or whether the practice of prescribing proprietary lines should he discontinued. The Government intends to endeavour, by means of a formulary, to cover all the essential prescribing requirements of the medical profession, and, in order to achieve this, the Government’s policy will be to include all drugs of proven therapeutic value. All combinations of drugs of therapeutic value will be included, and any variations the doctor may require in the matter of proportions can be made within the formulary itself. The formulary will cover all specific treatments; that is, when it is known that a drug will definitely cure a disease or illness, such drug will be included, and by means of the formulary complete coverage of the doctors’ requirements for such diseases and illnesses will be met. Of every 100 prescriptions written by doctors at least 40 are of this specific nature and will be covered fully by the formulary. The other 60 prescriptions out of every 100 as written by the doctor are palliative medicines and include such things as pain-relieving drugs. The formulas proposed will cover the great majority of prescriptions of this nature. This will mean that such medical prescriptions as are outside the servicewill be in the category of luxury, excessive or unessential prescriptions. In this way the formulary will be based on scientific principles and be kept in line with the most modern methods of curative and preventive medicine.
– The Minister’s time has expired.
.- When the Minister is asked for a simple explanation of a clause he becomes rather heated, and seems to assume that those who suggest an amendment of a clause, or ask for information regarding it, are antagonistic to the bill. The desire of members of the Opposition is to improve the bill, if we can.
– Order ! The honorable senator must confine his remarks to the clause and the amendment.
– In his speech on the motion for the second reading of the bill, the Minister said that any prescription of value could be included in the formulary, if it were accepted by the formulary committee. He also remarked that any prescription not included in the formulary would not come within the scheme. Therefore the doctors’ prescriptions are to be standardized. Under the scheme, doctors will be unable to prescribe any medicine not provided for in the formulary. The doctors are to be confined within narrow limits. We say to them, “ Never mind what you think is of value to your patients. Prescriptions not in the formulary may not be used “, The Minister also stated that biological preparations such as insulin and anti-toxinswould be included in the formulary. In consequence of this scheme therewill be a vast increase of the number of prescriptions that doctors must provide, and a great increase of the prescriptions which chemists must dispense. Many patients will want the most expensive drugs, because they will probably have read in the press of sensational cures effected by their use. The work of the medical practitioners, despite their ability and training, is to be severely circumscribed. Should they desire to prescribe different treatment from that set out in the formulary they cannot do so unless the patients pay for it. If the Minister faces the facts fairly he must realize that the doctors will not have a free hand to treat their patients. It is true that, should a doctor develop a prescription of value,he might ask the formulary committee to accept it, but doctors know from experience that those who get away from the beaten track often experience a cold shoulder. I doubt the ability of the doctors to induce the formulary committee to accept prescriptions not preconceived by it.By this clause we shall do a disservice to the people whom we desire to benefit. The Minister’s reference to four flavourings leaves me cold, because exceptional cases can always be found. I studied medicine for a couple of years and have had some experience at the outpatients department of the Melbourne hospital. My experience there has made me most sympathetic towards those in need of medical attention, and if in any way I can help them to return to a normal state of health, or can prevent others from getting into their unhappy condition, I shall do so. I am sympathetic towards the Minister’s intention, but he should know that his proposal will mean the restriction of the medical profession within narrow limits.
– We are gradually getting to understand the Government’s intention in regard to this clause. The Minister for Health (Senator Eraser) has told us that a committee is to be set up to prepare a formulary of prescriptions for the treatment of the bulk of the ills to which human nature is heir, but when he talks of bringing Sir Henry Newland to Canberra to assist the committee I doubt whether that will be practicable. Is it intended to prepare prescriptions for the treatment of such complaints as chilblains, gumboils, whooping cough, rheumatism and hiccoughs? If so, why require the affected person to go to a doctor and pay 10s. for a prescription? Why not number the prescriptions from 1 to say 500, with a number against each complaint from which a person may suffer, thereby making it possible for a sufferer from ‘chilblains to examine the chart and go to his chemist and ask for say, prescription number 206? I could understand a committee consisting of experienced medical practitioners, who realize the value of the various drugs and also know their cost, drawing up a formulary which would enable a patient to know that he would not be overcharged by a chemist for the medicine prescribed by a doctor. If, however, it is to be a matter of a patient going to a doctor for a prescription, which will be handed to him and to others more or less in bulk, the whole thing becomes ridiculous. Unless the scheme be made comprehensive and people requiring medical attention are given service for their money, and unless they are permitted to get from the chemist the things that are necessary for their cure, we shall not improve the health of the nation. A doctor may diagnose a patient’s trouble as being due to some minor ailment in its early stages, but it would not necessarily follow that the treatment to be prescribed would be the same for him as for a person suffering from that ailment in an advanced stage. If we are to provide free medicine for the people, let it be free medicine in fact.
– As I understand the statement of the Minister for Health (Senator Fraser), it is self-destructive. The Minister said that everything necessary for the treatment of disease would be included in the formulary. If so, what is his objection to allowing a medical practitioner to prescribe anything contained in the formulary, and for the Government to pay for the prescription? Honorable senators opposite should realize how the proposals of the Government will react to the detriment of the poorer sections of the community, unless the formulary be absolutely complete as regards the new and expensive drugs. We are passing through a stage of development similar to that which followed the war of 1914-18, in that science is making great and rapid advances. New methods of treatment are being discovered almost every day, and, therefore, if we are to make this legislation worthy of ourselves, there should be no restriction whatever of the drugs which may be prescribed. The amendment of Senator Wilson is more limited in scope than are the proposals of some other honorable senators, because it does limit the cost to be borne by the Treasury. The attitude of the Minister appears to be that the medical man who is in personal contact with a patient, knows his constitution and medical history, and has examined him frequently is not to be trusted to prescribe what medicine is necessary for him, whereas some gentlemen sitting in Sydney, Melbourne, Canberra, or elsewhere, who have never seen the patient, are in a better position to prescribe the most effective treatment. The most skilled scientist may be a mere theorist with no practical experience of dealing with patients. There may be some justification for the criticism of extravagant prescriptions; but not every person in the community can take certain drugs without some flavouring being introduced to counteract other qualities in the medicine. It is frequently necessary to introduce flavourings into medicines to make them palatable to patients. There may be other things which the pure scientist regards as fanciful, but which the family doctor who understands his patient knows are necessary for his recovery. Any suggestion that medical practitioners generally would make a habit of prescribing unnecessary drugs is an unwarranted reflection on the medical profession. We all know the care exercised by medical practitioners generally in prescribing treatment for those whose lives are entrusted to their care. The Minister would be well advised not to place any restriction on the medicines which may be prescribed, because should it be found that the medical profession is acting wrongly the abuse could be quickly corrected by the Parliament. Why should a patient who is allergic to certain things be deprived of treatment which his family doctor regards as best for his cure ? The purely theoretical scientist may regard these peculiarities of patients as so much “ hooey “, but the man who attends a person in his illness, and has perhaps visited him scored of times, knows his constitution and temperament, and is best able to prescribe the kind of treatment that is likely to be successful. Human beings are less able to deal with their bodily deficiencies than are some of the lower animals. For instance, when a horse in training develops some ailment, the owner calls in the veterinary experts who prescribe all sorts of remedies. Yet, when the unfortunate animal is turned out to a paddock, the first thing he does is to eat dirt. Recently, one of my horses developed serious trouble, and when I turned him out to a paddock, after the veterinary experts had failed to improve his condition, he proceeded to eat the bark off every English tree on my property. Much the same can be said about other animals, such as cats and dogs. We are led to the conclusion that human beings are not sufficiently educated to remedy their own ills without the services of experts who have undergone a course of highly scientific training. The higher animals know more about themselves than human beings. I have the greatest respect for the scientist, but I submit that in this instance we should rely to the greatest degree upon the general body of medical practitioners because the general practitioner is in close touch with his patients. The old family practitioner is able to handle the family more effectively than the specialist who is called in on very serious cases ; and on such occasions, the specialist consults with the family practitioner who, he knows, has more intimate knowledge of the patient’s constitution and temperament. I appeal to the Minister in the interests of fair play not to throw a burden upon the patient who cannot afford to pay for the more expensive drugs when such are prescribed by his practitioner. The Minister said that honorable senators who supported the amendment were not aware of the pitfalls involved in such a proposal. I venture to think that the need for this provision arises only in the imaginations of gentlemen who look at the problem through the spectacles of the higher scientist, and fail to bear in mind the practice followed by the general practitioner. It is of no advantage to the general practitioner to prescribe fanciful drugs, except, perhaps, in a few instances in order to render the dose a little more palatable to his patient. The general practitioner derives no benefit by increasing his patient’s bill to the chemist. He is forbidden to have such an association with the chemist. I realize that in very remote localities the doctor himself will dispense his own prescription; but such cases are rare. Therefore, I fail to understand why the Government refuses to accept the amendment. If it believes that by doing so, it would place too great a burden upon the scheme, as the result of abuses which might arise, it could place a limit upon the cost of prescriptions coming within this class. It can thus provide some measure of relief to those persons who otherwise will be deprived of benefit under the measure. I ask the Minister not to leave this blot upon the bill. There is no foundation for the suggestion that the general practitioner prescribes fanciful prescriptions.
Question put -
That the words proposed to be added (Senator Wilson’s amendment) be added -
The committee divided. (The Chairman - Senator Courtice.)
AYES: 17
NOES: 18
Majority . . . . 1
AYES
NOES
Question so resolved in the negative.
Amendment negatived.
Question put -
That the clause stand as printed.
The committee divided. (The Chairman - Senator Courtice).
AYES: 18
NOES: 17
Majority . . . . 1
AYES
NOES
Question so resolved in the affirmative.
Clause agreed to.
Clauses 8 to 10 agreed to.
Clause 11 -
A hospital authority may make application to the Director-General for approval to supply pharmaceutical benefits.
Every such application shall state the person who will dispense or supply the pharmaceutical benefits on behalf of the hospital authority.
The Director-General may, in his discretion, approve a hospital authority for the purposes of this .act.
.- I direct the attention of the Government to the necessity to provide for some safeguard in respect of what shall constitute an approved hospital authority. Personally, I am opposed to all private institutions being designated as hospitals which do not have a resident doctor on the premises. The majority of private hospitals are doing very good work, but many of them can only be classified as antiquated institutions. With the development of medical science, it appears to be the object of the specialists to congregate all dangerous and scientific cases in big central institutions. In a small cottage hospital which has no resident doctor the patient is exposed to undue risks. I have had brought to my notice recently three cases showing the urgent necessity for a medical practitioner to be on the premises. The first was that of a farmer who had a scratch on a hand or wrist and suffered from blood poisoning. He entered a private institution which had not a resident doctor, and the matron or sister in charge did not know exactly what to do. The poison had worked up the patient’s arm, and he was still being treated with hot fomentations on his wrist or band. Those doing the job were quite incompetent. When I saw him he was nearly unconscious and did not know me. I sought his father and told him the position. The father immediately sent for the ambulance, and had his son taken to another hospital. I consider that my action in finding the father saved the man’s life. The second case was that of a youth of nineteen who was ill with pneumonia in a private institution at Hobart. He was receiving oxygen treatment. While his father was with the youth the oxygen apparatus broke down. The doctor was absent and as there was nobody on the premises who could repair it, the father attempted to, but the youth passed away while the oxygen cylinder was not in operation. If there had been a resident medical man in the institution, the boy’s life could have been saved, because a doctor could have given him the oxygen by other means. The third case was that of a woman of twenty, who was operated on for goitre in a private hospital where there was not a resident medical man. She had a fit of coughing, and before the doctor could be brought to her she died. In cases of heart disease, goitre, pneumonia and other dangerous diseases it should be compulsory for a private hospital to have a resident doctor. It should be provided in this bill, and also in the hospital legislation which is to follow, that no benefit shall be provided to any institution which has not a resident medical practitioner.
– I move-
That, in sub-clause (2), after the word “authority”, the following words be added: - “ Provided, however, that such person shall be a qualified pharmaceutical chemist.”
In the amendment circulated the words which I proposed to add included also the following : “ or, if no such chemist is available, a medical practitioner “. I have since ascertained that these words are unnecessary as medical practitioners are covered by clause 9. The object of this amendment is to ensure that only skilled persons shall be permitted to prescribe medicines. Honorable senators will recall the recent sad case in Victoria where a nurse instructed a staff sergeant to get a bottle of medicine from a dispensary. The sergeant got a bottle of strychnine by mistake, and a portion of the contents was administered to a member of the Australian Women’s Army Service, who died. All honorable senators will realize the danger of drugs being handled by inexperienced persons. Under clause 11, as it stands, it would be possible for any person to be approved to dispense medicines in a hospital. The object of my amendment is not to detract in any way from the rights of hospital authorities - I agree that in many cases it is essential for a hospital to have some one on the spot to dispense medicines - but I contend that no person should be permitted to do that work unless he or she has the requisite qualifications. My amendment limits persons who may be approved under clause 11 to act as qualified pharmaceutical chemists. In cases where a chemist is not available, clause 9 provides that a medical practitioner may prescribe medicine. With confidence I ask the Government to accept this amendment.
– I hope that Senator Wilson will not press his amendment. In many outback areas of the Commonwealth, particularly in Western Australia, there are small hospitals which have neither a qualified dispensing chemist nor a resident medical officer, and the task of prescribing simple medicines is usually performed by the matron. If this amendment were carried, the working of these institutions would be severely hampered. The Government cannot accept the amendment.
Amendment negatived.
Clause agreed to.
Clauses 12 to 15 agreed to.
New clause 15a.
Motion (by Senator Fraser) proposed -
That after clause 15, the following new clause be inserted: - “ 15a. The Minister may, on behalf of the Commonwealth, enter into an agreement (on such terms as to remuneration, allowances and otherwise as he thinks fit) with any medical practitioner providing that the services of the medical practitioner shall be available without charge to members of the public for the purpose of furnishing prescriptions and orders for the purposes of this act.”
– I regard the conduct of the Minister for Health (Senator Fraser) in moving this amendment as extraordinary.. In the first place, the amendment was circulated only yesterday, although apparently it was printed on the 25th February. I am surprised that the Minister has not given to the committee some idea of the cost of what is proposed in the clause which he now seeks to insert in the measure. The clause provides that “ The Minister may, on behalf of the Commonwealth, enter into an agreement, on such terms as to remuneration, allowances and otherwise, as he thinks fit with any medical practitioner . . .”. Running true to form,, and once again displaying, the strict partisanship which in the past has been shown towards union sects, and its own supporters, the Government seeks now to place in the hands of the Minister for Health power to declare that his own. friends shall, have free medical attention. Is that the meaning of the proposed new clause? If not, does not the Minister intend to inform the committee of its meaning ? Surely he cannot expect the Senate to swallow an important proposal such as this, which, on the face of it, appears to be the first step towards the nationalization of the medical profession. This is most unsatisfactory conduct. Surely honorable senators are entitled to hear from the the Minister something about the purpose of the clause and what its cost will be.
– I should like to dispel the wrong impression which has been gained by honorable senators opposite. The clause is designed to cover emergency cases. The Minister may decide that it is in the interests of a particular section of the community, particularly people in an outback district, who may have to travel for miles to get a prescription, that medical attention should be provided.
Were it the intention of the Government to do “what has been suggested by the Leader of the Opposition (Senator McLeay), it could easily appoint medical practitioners under the Public Service Act, but surely it will not be suggested that in cases of emergency, where patients may be suffering acutely, the whole machinery of that act in regard to appointments should operate before medical attention could be given ?
– The Government is merely filling a gap in clause 15?
– Yes, remedying an oversight in the drafting of the bill. Reference has been made by the Leader of the Opposition to a desire on the part of the Government to provide free medical treatment for trade union secretaries or members of Labour organizations, but nothing of that kind has entered the mind of the Government.
.- I am as surprised by the Minister’s explanation as I am by the clause. The Minister asks us to believe that clause 15a is intended to apply only to isolated areas and in emergency cases.
– I did not say that.
– I understood that, in reply to an interjection, the Minister 3aid the clause was required to fill up a gap in clause 15, which applies only to persons living in isolated areas or under such conditions that the benefits of the scheme could not be efficiently provided’. It is very easy for the Minister to say that, in the case of persons living in isolated areas or under exceptional conditions, he should have power to make arrangements with doctors to supply them with prescriptions; but the clause is not limited to isolated cases or emergency conditions. It applies to any set of circumstances to which the Minister sees fit to make it apply. It would be competent for the Minister to arrange with doctors to supply trade unionists with free prescriptions. In other words, the Minister is taking to himself the power to make his awn laws. He is asking the Parliament to hand over to him the power to determine whether certain sections shall be able to get free medical treatment. If the Minister intends that all people shall be able to get free treatment let him say so. When he introduces a clause to that effect, I shall deal with it. This clause provides that the Minister, if he wishes, may say that all people shall get free medical treatment, or he can say that only those people who support his political party or are members of trade unions shall get that benefit.
– Does the honorable senator think that that is possible?
– Yes.
– I am glad that I have not the honorable senator’s nasty mind.
– I am glad that I have not the Nazi outlook of this Government. One could not imagine a nearer approach to the whole philosophy of the Nazis than to leave the Minister to decide whether John Brown or Bill Smith shall get this or that advantage.
– The honorable senator was insistent the other day that the Minister must be supreme, but now he wants it the other way.
– The Minister is not doing himself justice. What I said the other day, and what I should always say, is that the function of the Minister is to administer the law, but my complaint about this clause is that it leaves the Minister the right to make the law.
– At times Ministers in all departments have to use their discretion.
– Yes, within the limits of the law, but this clause provides no limit whatever to the Minister’s discretion. If the Minister desired to give the benefit of free medical treatment to trade unionists, he would be within the law in doing it, and I object to the placing of that power in the Minister’s hands. If the Minister expresses the mind of the Government on this matter when he says that the clause is intended to apply only to people living in isolated areas and under special conditions, let him state that in the clause. I thought that the Minister would welcome a limitation of the wide discretion given by the clause. A member of Parliament might say to him, “ I have some very poor people in my constituency and I want you to include them”.
– What would be wrong with that?
– First the benefit was to be given to people living in isolated areas and under special conditions, but now the Minister admits that the object of the clause is to enable him to provide free medical attention in order to satisfy the demands of politicians.
– That is merely the honorable senator’s interpretation.
– That is a fair construction to place on the Minister’s remarks. I suspected at the outset that the first explanation given by the Minister was not a complete one.
– I am more surprised than ever at Senator Spicer. Recently he strongly objected to sole power being given to a director-general and not to a Minister, but now, when sole power is to be conferred on a Minister, the honorable senator raises the same barrage of objection. He wants “ a bit both ways “. Yesterday, he opposed this bill on the ground that people would have to pay 10s. 6d. in order to obtain a bottle of medicine free, and he said that it would be better to give people free medical advice than free medicine. In some of the outback districts of Australia the appointment of doctors to give medical attention to settlers will be desirable. No one knows better than does Senator Spicer the serious shortage of doctors in our cities. It may be necessary to appoint doctors in some of our cities to supply prescriptions for those in need of medical attention.
– That is already done in some factories.
– There is nothing new in the proposal. If honorable senators opposite were to read what is taking place in this country they would know that in one State about a dozen doctors have been appointed to provide prescriptions which are paid for by the State Government. There is nothing wrong with this provision. It sets out that should it be necessary to appoint a doctor to issue prescriptions and provide medical attention, the control shall be in the hands of the Minister. Who else should have the control? Honorable senators who complain to-day about the control being vested in the Minister expressed an entirely opposite view when dealing with another bill which was recently before the Senate. The clause meets the wishes of many honorable senators opposite, including Senator Wilson. It has been contended that a person in need of a bottle of medicine will not be able to get a prescription for it without paying 10s. 6d. for a doctor’s prescription. This clause will empower the Minister to appoint doctors for the whole of Australia should the Government think fit to do so. I shall not balk that issue. I shall not be satisfied until free medical attention is provided for the whole of the Australian people. I should not restrict that service to any section of the people. The objection raised yesterday by honorable senators opposite that the expense associated with the obtaining of a prescription was not justified has now been met, because the proposed new clause provides that the Government may appoint doctors to give free prescriptions to those who require medicine. The objections raised to the bill yesterday have been met and now honorable senators opposite claim that the measure is a form of Nazi-ism. Those who think so must have minds as low as a sink.
SenatorLECKIE (Victoria) [4.55].- The cat is now out of the bag; in one simple clause provision is to be made to provide medical benefits, without restriction, for the whole of the people of Australia. Without any explanation, or estimate of the cost involved, the Minister calmly submits a proposal which would cost the community at least £7,000,000 a year.
– How does the honorable senator arrive at that estimate?
– A doctor cannot give proper attention to more than 1,000 persons. On that basis, 7,000 doctors would be required to meet the needs of 7,000,000 people, and each of those doctors would be entitled to a payment of £1,000 a year. How is the National Welfare Fund, which already is well nigh exhausted, to meet the demand which will be made upon it? «
– If the honorable senator repeats the statement often enough he will convince himself that the National “Welfare Fund is really exhausted.
– The calls upon the fund which have already been agreed to are likely to exceed £30,000,000 a year. Should the Minister introduce a bill to provide medical (benefits for the people, it will be sympathetically considered by honorable senators on this side, but the proposal to introduce in this bill a clause which might have the effect of multiplying three or four times the expenditure under the bill as originally drawn, is the most remarkable piece of attempted legislation that I have ever seen.
– The honorable senator is not a good mathematician.
– That may be, but I cannot compete with the honorable senator in versatility of deficiencies. I believe that the Minister in charge of the bill desires to be honest with the committee. If he wants to provide medical benefits for people in remote districts, or in special cases, any proposal of that kind will be sympathetically considered by the Opposition. “We must, however, confine the bill before us within certain limits. Under the measure before us, a man who requires medicine may get it, but a man who breaks a leg will not be entitled to receive medical treatment. Therefore this measure does not envisage medical benefits in the full sense of the term. All that it provides for is medical advice and the supply of medicine. The Minister’s interpretation of the proposed new clause differs from that given by Senator Aylett. If it is intended to provide for special cases, or for the needs of people in remote localities, the Minister should say so, and we should then know where we stood. As it now stands, the clause means that the Minister can appoint duly qualified medical practitioners throughout the Commonwealth, and, as I have said, that would involve an expenditure of at least £7,000,000 a year.
– During the second-reading debate, honorable senators expressed the view that this scheme had apparently been drawn up hurriedly and without full consideration; and honorable senators on this side emphasized that the Government was starting at the wrong end of a medical benefits scheme by providing medicine free of charge rather than subsidizing the cost of medical service to people who could not afford to pay for adequate medical attention. I myself said that we should first subsidize medical services before providing the patient with a bottle of medicine free of charge after the patient had incurred the cost of consulting his practitioner. It is clear that this clause has been brought down as a makeshift arrangement to meet the objection that the bill represented a lopsided method of dealing with the problem. I believe that in dealing with the proposed new clause Senator Aylett interpreted, the intention of the Government far more accurately than did the Minister for Health (Senator Fraser). Senator Aylett said that the object of the Government was to provide medical service free of charge to all sections of the community in every part of the Commonwealth, whereas the Minister said that the intention of the Government was merely to apply this provision in isolated areas where no doctor was available in ordinary circumstances, and the cost of obtaining the services of the nearest doctor would be prohibitive to the average person. The Government proposes to insert this provision as an entirely new clause, that is, it now intends to introduce an entirely new principle into the bill. If the Government now intends to go a little farther and subsidize the medical practitioner, it should make that principle the subject of a special measure. It should deal with it as part of a scheme to provide free medical service, and not in conjunction with this scheme the object of which, as we have been told, is simply to provide medicine free of charge.
– This provision will not have general application. If provision is made to provide medical attention for persons in certain areas, it is hardly likely that the Government will require the patient to pay for such services.
– The services of parttime and full-time doctors are now provided in some factories.
– This provision should be inserted as a sub-clause of clause 15. Its application would thus be limited to special cases.
– It may be desirable to apply this provision in a metropolitan suburb.
– The Minister did not say that previously.
– I said in remote areas or in special circumstances.
– What are the special circumstances?
– We shall have to meet those circumstances as they arise.
– I shall support the proposed new clause provided that the Minister restricts the application of this provision to the conditions which he set out in his explanation of it, that is, that it shall apply only to people in outback or isolated areas where medical practitioners are not available in ordinary circumstances. If this provision be inserted as a new clause it will introduce an entirely new principle, because it is not associated with any other provision in the bill.
– In opposing almost every clause in this measure, honorable senators opposite are observing the dictum of that great imperialist, Lord Randolph Churchill, who declared in the House of Commons that the duty of an Opposition is to propose nothing, oppose everything and turn the Government out. As Senator Aylett has said, the proposed new clause will meet every case which it is desired to meet. I support the proposed new clause because it will improve the measure.
– The proposed new clause gives to the Minister for Health (Senator Fraser) amazingly wide powers. As has been pointed out, he can decide that free medical attention shall be given to every person in the community under this clause, or he can apply the provision to certain, sections of the community, or he can decide not to apply it at all. Let us assume that the Minister does what Senator Aylett and Senator Darcey have suggested, and decides that all prescriptions shall be free, namely, that the Government will pay the consulting fee of the practitioner in respect of all prescriptions. The Minister said that it is estimated that 20,000,000 prescriptions per annum will be dispensed. Let us assume that the practitioner will be paid as much after the passage of this measure as he has been paid in the past, that is, at least 10s. 6d. for diagnosing a case and prescribing for it. On the basis of 20,000,000 prescriptions being dispensed each year, and a rate of reimbursement to the medical practitioner of 10s. for each prescription, the additional cost involved in this innocent-looking amendment would be £10,000,000 per annum. Senator Leckie estimated the amount a*: £7,000,000, but, on the Minister’s own figures, if the Government did what Senator Aylett suggested it would cost about £10,000,000 a year.
– Has the honorable senator ever heard of such a thing as paying doctors a salary?
– If the Government takes over 6,000 members of the medical profession and pays them £1,000 a year each, as has been suggested, the cost of the scheme will be £6,000,000 a year. So, by a simple amendment, without any mention of it in the Minister’s second-reading speech, and without warning to the public, the committee is asked’ to load the bill with a provision which, if the Minister exercised his fullest powers, as he has been urged to do by a certain number of his back-bench supporters, it would cost the Commonwealth anything from £6,000,000 to £10,000,000 a year. If the Government wishes to provide free medical advice for the Australian people, it should do so by introducing a bill for the purpose, and not by the back-door method of inserting in this bill, at this late hour of its consideration, a new clause enabling the Minister, if he chooses, to decree by a wave of the hand that all medical services- shall be free. But let us suppose that the Minister, instead of doing what Senator Aylett suggests, simply decrees, as one honorable senator opposite has suggested, that free medical services shall he provided in factories. That would be most unfair discrimination against all rural workers. If free medical attention is to be given, the Government should extend it to the whole of the people. I am extremely suspicious of the Government’s motives, and I am not surprised that certain honorable senators have pointed to the close parallel between its actions and the methods of the Nazi and Fascist parties. What is this country coming to if the Government can, by a wave of the hand, incur an expenditure of from £6,000,000 to £10,000,000 a year, and at the same time decree that the benefits shall be available only to members of their own party and their friends? Are not those just the methods adopted in Nazi Germany and Fascist Italy, where benefits were provided for the few and denied to the many? I ask the Government not to press the new clause. If it desires to provide free medical services, let it introduce a bill to do so. If it intends to provide free medical services for one section of the community, let it say so frankly, and not use a back-door method enabling the Minister to pick and choose those who are to receive the benefits and those who are not. I shall oppose the new clause.
– I should like to hear the Minister say whether he will consider an amendment on the lines indicated by Senator Foll, in keeping with clause 15, so as to give the proposed new clause a limited operation. Honorable senators have spoken very freely of the dangers of placing such wide powers in the hands of Ministers. We have had evidence of the extent to which they can be and have been abused. I take this opportunity to draw attention to what could happen if this power were vested in the Minister. He could decide whether men on strike at Newcastle were to have free medical services or medicines, and whether the provision should apply to unionists only, or returned soldiers only, or only to the members of his own political party. I remind the committee of how a similar power has already been abused. The following letter addressed to the Commonwealth Public Service Board was written at Parliament House, Canberra, on the 16th May, 1943:-
The Government desires, as a matter of policy, that the provision of any determination already made by the Public Service Arbitrator, but which is not yet enforced, or of any determination that may be made subsequent to the 19th May, 1942, shall be applied only to returned soldiers and members of an organization within the meaning of the Commonwealth Conciliation and Arbitration Act.
That is a glaring example of preference to returned soldiers and unionists, and is signed by “ John Curtin, Prime Minister “. It is evidence of political patronage, and of the extreme lengths to which the Prime Minister (Mr. Curtin) himself was prepared to go in order to obey a caucus decision. I appeal to the Minister, in the interests of good government, and in an endeavour to create confidence in the minds of the people, to indicate whether he is prepared to accept an amendment along the lines suggested by Senator Foll. If he will not do so, we shall have to. oppose the new clause.
– Senator Wilson and the Leader of the. Opposition (Senator McLeay) have made most extraordinary statements. I do not know whether their imagination has run riot, or whether they are deliberately trying to exaggerate to the point of making themselves ridiculous. Senator Wilson talks of the Government putting the whole of the medical profession on a salary basis, by which means people would be able to obtain free medical services. I am unable to understand the reasoning of anybody who could visualize bringing into effect the nationalization of medicine by means of such a flimsy clause as this.
– Would not the honorable senator admit that it could be done by means of the new clause?
– No, I am certain that much greater preparation would have to be made, and many fartherreaching provisions introduced, before the Government could put 6,000 medical men in Australia on a salary of £1,000 a year each. I do not say that it might not be a good thing to do so.
– But it could be done under the new clause.
– If the honorable senator thinks so, his brain must work in an entirely different way from mine. During the consideration of the bill, much criticism has been levelled at it by the Opposition because, in order to obtain free medicine, it is necessary to pay for a doctor’s certificate. Great stress has been laid on the fact that a free bottle of medicine cannot be obtained unless a doctor’s fee of 10s. 6d. is paid. Members of the Opposition laid great emphasis .on that argument, which I admit appealed to me very strongly. I also know that there has. been some discussion on the point, and that the Minister has been endeavouring to find a suitable way of overcoming the difficulty. I sympathized with the Opposition when they argued that, this measure did not, in effect, provide free medicines because a patient would have to pay a doctor’s fee before he could obtain a prescription; now that the Government has found a solution of. that problem, there is general opposition to it. To-day nearly half of the people of this country - I think that the figure is approximately 2,500,000 - are members of friendly societies. Those people will not be put to any expense to obtain a doctor’s prescription. In addition, there are many medical schemes in operation throughout Australia. In the district in which I live, it is a common practice for people to pay 10s. or lis. a quarter to a doctor for the right to obtain free medical attention in the event of sickness. Such schemes cover many thousands of people, and they, too, in addition to members of friendly societies, could obtain a doctor’s prescription free of charge. Then there are the hospital out-patients departments, which also could issue prescriptions under this scheme. However, it is true, that there is a section of the community which would not be covered, and because the Government believes that those people should not be debarred from receiving medical attention free of charge, this proposed new clause is to be inserted in the bill. Under proposed new clause 15a the Government will have power to enter into a contract with a medical practitioner to examine certain individuals and issue prescriptions so that those individuals may obtain free medical treatment and medicines.
– Why not apply that to everybody?
– It is strange to hear opposition to this proposal in view of the previous argument raised by honorable senators opposite that a person suffering from an illness would have to pay a doctor’s fee before he could receive free medicine. Apparently, the Opposition fears that this provision might be used for some utterly ridiculous purpose. The proposed new clause is a worthy provision which fills a gap in the bill, by making provision for a large number of people who otherwise would not be able to obtain free of charge a prescription from a medical practitioner.
.- The more supporters of the Government endeavour to explain the proposed new clause, the more it becomes evident that the provision represents an entirely new principle in this measure and that the title of the bill should now be changed to the Pharmaceutical and Medical Benefits Bill. .Senator Arnold made the most extraordinary statement that approximately 2,500,000 people in this country were members of friendly societies, and therefore could obtain a doctor’s prescription free of charge. Surely the honorable senator knows quite well that these people have to contribute to the funds of the friendly societies and’ that this clause, if inserted in the bill, would be an encouragement to people to leave the friendly societies and take advantage of the free medical service that is now proposed. That is the only interpretation that can be placed upon the clause. However, if the object of the new clause is, as the Minister has indicated, to afford medical attention to people in isolated areas, it will have my support, and to make the intention of the clause quite clear, I move -
That, after the word “ public “, the following words be inserted : - “ living in isolated areas or under such special conditions that the benefits of the Act cannot be efficiently provided “.
That amendment, if carried, would bring proposed new clause 15a into line with the provisions and limitations of clause 15. If the object of the proposed new clause is as the Minister has stated, then it is to be commended, but if it means the inauguration of a scheme of free medical treatment, then it is a matter which should be the subject of consultation with experts of the two departments under the Minister’s control. I appeal to the Minister to accept my amendment in order that the intention of the proposed new clause may be made quite clear.
– I rise to order. I should like to know, Mr. Chairman, if the committee is in order in considering an amendment when a proposed new clause is already before the Chair?
– Proposed new clause 15a may be treated as any other clause in the bill, and an amendment of such proposed new clause may be moved.
.- I confess that I should be assisted greatly in my approach to this matter if the Minister 0for Health (Senator Eraser) were frank with us about the intention of the proposed new clause. We have had three explanations from honorable senators opposite of the purpose of the clause. First, the Minister stated that it was intended to cover the special cases referred to in Senator Foil’s amendment. If so, the Minister should not object to the position being specified quite plainly. However, whether or not the Minister’s explanation was the correct one, apparently there are several honorable senators opposite who do not agree with it, because they have made explanations which are inconsistent with the explanations given by the Minister. In fact, they are in direct conflict with it. I hope that I am not misrepresenting the Minister when I say that his first explanation of the object of this clause was that it was designed to fill a gap which had been observed’ in clause 15. The Minister does not deny that that was his explanation. That being his intention, the clause can operate only in the circumstances referred to in Senator Foil’s amendment. Why cannot that be stated clearly in the clause? That is not the explanation given by Senator Arnold, who stated frankly that the clause is intended to make general provision whereby the members of the community can obtain medical services for nothing. What the honorable senator has overlooked is that the clause does not give that right to every member of the community, but only to those whom the Minister thinks should have it.
– Apart from those already covered.
– The honorable senator is referring to the fact -that members of friendly societies can obtain medicines without paying 10s. 6d. to a doctor, but the members of those societies do not get their medicines for nothing. Does Senator Large wish to place them at a disadvantage? He desires them to remain members of those societies, but others are to be relieved, at the will and command of the Minister, of the obligation to pay for medical treatment.
– In special circumstances.
– There is no reference in the clause to special circumstances. If the Minister gave that wide application to the clause it would in one fell swoop destroy the friendly societies. Why should a person contribute to such a society for medical attention when he could get similar attention elsewhere for nothing. If the Government wishes to be remembered as the destroyer of the friendly societies it will adhere to this clause, but if it wishes to reduce the provision to the limits which the Minister himself has already set to it, it should accept the amendment.
– If the Minister desires to make provision for free medical treatment to people in poor circumstances, and if he can indicate to the committee a method by which such people will come within the provisions of the clause, I shall support him. Branches of friendly societies are established throughout the Commonwealth in large numbers, but it is entirely beside the point to say that their members get free medical attention. A few moments ago, Senator Arnold stated that in addition to the members of friendly societies he knew of many people who, by mutual arrangements with doctors, made regular contributions to entitle them to medical attention whenever they required it.
– Doctors’ clubs are common.
– Yes. lt would be unjust, however, to single out one section of the people, if others who are not provided for by friendly societies, doctors’ clubs, or medical schemes such as those provided in connexion with large industrial organizations, are to be covered by this scheme at the discretion of the Minister. If in areas similar to the Northern Territory, where people live in isolation, assistance could be given to them in order to place them at no disadvantage compared with the residents of the more thickly populated parts of the Commonwealth, such a course should be followed. Much must be left to the discretion of the Minister, and we must assume that the wide power to be given to him will not be abused. We need to know whether the class to be covered can be clearly defined in the bill. I do not take an extreme view, and therefore I do not agree with the remarks of Senator Wilson. The people would rise against and would remove from the treasury bench a. government which attempted to do what the honorable senator suggested. If the Minister will indicate that the proposed new clause is intended to cover only cases of hardship and persons living in remote areas, I shall support it. It may be possible to meet such cases by remitting the charges. I should like to know what is intended.
– I object to having imputed to me words that I did not utter. There is such an art as lying by inference ; it is an art to which lawyers sometimes resort. I did not utter the words which Senator Spicer has attributed to me. The clause itself reveals its purpose ; it is intended to cover a few isolated cases.
-. - It does not say so.
– It is meant to cover isolated places, or peculiar circumstances which are not covered by the general provisions of the bill. When Senator Arnold pointed out that esti mates of cost had gradually risen from £7,000,000 to £10,000,000 a year he said that the estimates were incorrect inasmuch as the proposed new clause could not be a dragnet provision because most of the people were already covered by friendly societies or in some other way.
– They are not covered.
– Such persons are not required to pay 10s. 6d. for a doctor’s certificate. Members of friendly societies pay an annual sum to the society, whilst others in the community, who are members of doctors’ clubs, pay a fee quarterly, half-yearly or yearly. On attaining the age of sixteen years many young people join either a friendly society or a doctors’, club. My own daughter chose the latter form of cover. Senator Herbert Hays said that if the Minister would indicate that the clause was intended to cover only cases of hardship or of isolation he would support it. He did not agree with the remarks of Senator Wilson. I am a member of a friendly society and I believe that such societies are rendering valuable service to the community, but I do not pat them on the back for that. The very existence of such societies is a condemnation of capitalist governments which have refused to accept responsibility for the health of the people. Friendly societies have risen up because many persons in the community have wished to provide some form of insurance against sickness. Successive governments have taken advantage of the fact that certain elements in the community have ‘set out to help themselves by forming friendly societies for mutual protection and benefit. I claim it is the duty of any government to accept responsibility for the health of the community.
– Members of the friendly societies are to be commended for their self-reliance.
– I agree with the honorable senator. At the same time, 1 blame successive governments for having evaded their responsibility. Fortunately, the present Government recognizes its duty and is accepting responsibility for the people’s health, and for providing economic security to all sections of the community. As part of its plan to provide that economic security the Government has prepared a number of bills, some of which are now before this Parliament. In addition to accepting responsibility for the health of the people it is the duty of the Government to ensure that the .people are properly housed, fed and clothed. I want to show how hollow is the lip-service of some honorable senators opposite who “ blah “ about friendly societies. It has been said that if the proposed new clause means what Senator Arnold is credited with having said it means, the friendly societies of this country will be destroyed. By its social welfare legislation the Government will lift from the shoulders of friendly societies and similar bodies the responsibility for the health of the people. As I have said, I commend the friendly societies for the good work that they have done. I do not think that they will pass out of existence for the next ten or fifteen years. They may do so twenty years hence. “We are now entering upon a period of transition, during which the friendly societies will gradually go out of existence, and the good work which they have been doing will be accepted as the responsibility of the national Government. The friendly societies have done noble work, but their job is virtually nearing completion. We must face that situation. Therefore, let us not be hypocritical in our attitude towards them. When the Government accepts its full responsibility in respect of social services, the need for the existence of friendly societies will cease.
– The Minister said that this provision does not affect friendly societies.
– I did not hear the Minister say that. It does not affect them at the moment. They oan still carry on. When the Government undertakes certain functions which the friendly societies already perform, those societies will undertake other functions in order to give an improved service to the community. That is the role which the friendly societies will play during, the period of transition which we are now entering. However, it will probably be another twenty years before we can say that friendly societies have outlived their usefulness. I hope that I have nailed the lie perpetrated by honorable senators opposite by misrepresenting an interjection which I made earlier concerning the effect pf this measure upon friendly societies.
– I should like to ensure that remarks which I made a few minutes ago with -respect to friendly societies will not be misunderstood. I said that if the Government intends to cover cases of hardship outside the scope of the services rendered by friendly societies I would support the amendment. However, some honorable senators have implied that I said that the Government intends to compete with friendly societies. That is not the case. It is well known that free medical service is provided completely free of charge under the friendly societies scheme only when the patient resides within a specified radius of the lodge doctor. That radius used to be 3 miles. At the same time, any member of a lodge who lives outside that radius is obliged to’ pay a mileage rate in respect of the distance travelled by the lodge practitioner. Thus, lodge benefits are greatly reduced to members living, say, 8 or 10 miles outside the prescribed radius. That was the kind of case I had in mind when I was dealing with this subject.
– I suggest that honorable senators are entitled to the courtesy of a reply from the Minister in charge of this bill (Senator Fraser). He has moved an amendment to insert a new clause in the measure. Subsequently he made only a very brief statement concerning the effect of the proposed new clause. He asserted that it was limited to persons in isolated areas or in special circumstances.’ Nothing contained in this clause limits the proposed new provision in that way. When interpreting a law, the courts take cognizance only of the specific content of the law. Judges pay no regard whatever to what may be claimed to have been the intention of the Government which made the law. Consequently, if the Government is sincere - and I believe that it is - in its efforts to provide social benefits to the people, the Minister should explain precisely the extent to which this provision will operate. In view of the remarks made by some honorable senators opposite, the Government has good reason to ask to be saved from its friends; because each of those honorable senators enlarged upon the scope of the proposed new clause. Senator Large, for instance said that the proposed new clause would sentence friendly societies to a lingering death. He said that friendly societies were an anachronism which must go out of existence, and be supplanted by a better system.
– I did not refer to the friendly societies as an anachronism. The honorable senator’s remarks are offensive to me. I ask that they be withdrawn.
– I withdraw the remarks complained of. However, the honorable senator admitted that although friendly societies had done a good job in the past and had rendered real service to many people, they would be no longer necessary when the new system now being introduced by this Government was put into operation. He said that friendly societies would die a lingering death. The proposed new clause is further evidence of this Government’s idea of a new order.
Sitting suspended from 6 to 8 p.m.
– I pointed out before the suspension of the sitting that, although the Minister made an explanation which he claimed set out the intentions of the Government in introducing the proposed new clause, the clause itself bore no relation to the explanation. That is typical of the treatment which we have experienced recently at the hands of the Government, which has shown a complete contempt for the rights of Parliament, and has to a much greater degree than ever carried on the business of the country by regulation instead of legislation. The Minister proposes to include in the hill a clause which gives to him the opportunity to introduce a national medical service at his own complete discretion. That is typical of the much vaunted new order which the Government is going to introduce. In a measure which was previously before this chamber the Government disclosed that its main idea was to regiment everybody under the control of some Minister, commissioner or committee. I hope that the Minister will show the courtesy due to this chamber by explaining precisely what the intentions of the Government are. If they are as stated by him on the first occasion, let him tell us why he will not accept Senator Foil’s amendment, which completely covers the requirements of the Government as set out by the Minister. I hope that he will explain why the new” clause was introduced, and the form of amendment he is prepared to ‘ accept.
– I do not intend to repeat everything that I have said. I know that the members of the Opposition are very versatile in debate, and ready to utilize any line of argument, but Senator McBride does not want to accept half of the explanations given by Ministers. The proposed new clause provides that “ the Minister may on behalf of the Commonwealth enter into an agreement- “
– Any agreement.
– Yes; and there are two parties to an agreement. The Government cannot accept Senator Foil’s amendment. I do not see why the Government should have limitations placed upon its actions. It will use the power asked, for as circumstances demand. Senator McBride wants to limit it to the backblocks. He ignores the fact that there are already in factories in this country part-time medical men paid by the Government. Senator Foil’s amendment means that such doctors must be stationed only at some specified place, which would be ridiculous.
.- The Minister has at last come completely out into the open. At the outset, the proposed new clause was a somewhat circumscribed proposal. The Minister’s first explanation was that it was to cover isolated places and special cases.
– As circumstances demanded.
– He explains now that the sky is the limit, and that he will go as far as he possibly can, except in respect of putting doctors into factories.
– There are doctors in factories now.
– The argument which the Minister advanced related to the placing of doctors in factories. They are placed there as a general rule to deal not with cases of sickness, but with emergencies, such as accidents. The proposed new clause does not cover that form of service. It simply uses these words : “ shall be available without charge to members of the public for the purpose of furnishing prescriptions and orders for. the purposes of this Act”. Therefore, the Government’s new clause does not cover accidents, and so does not meet the instance which the Minister gave, of doctors being paid by the Government to attend factories.
SenatorFraser. - What about industrial diseases, or cases where poisoning takes place?
– The Government can put a doctor into the factory if it likes, but under the new clause his only function is to prescribe medicine. He is not authorized by the clause to deal with accidents.
– Would not a doctor prescribe medicine for a man suffering from lead poisoning?
– Such a sufferer would be treated in his own home by an ordinary doctor. Lead poisoning is well guarded against, but if a man were unlucky enough to contract it, it would not be necessary for a doctor in a factory to attend to him. He would not be treated at the factory at all. To keep him there would expose him to further risks. It is obvious that the Minister has departed from the first assurance which he gave to the committee.
– That shows how unreliable his statements are.
– I do not think that the Minister meant to be unreliable. He probably meant exactly what he said, but his statements have been contradicted by some of his own supporters, who said that the new clause did not mean anything of the kind, and was actually introduced for the purpose of supplying free medical services to the general public. I doubt whether the Senate has the power to pass such an amendment. If the Minister carries out the intention of the members of his party, who have explained to the committee the purpose of the new clause, that will add greatly to the charges on the public exchequer. The committee has no right to make this amendment in a money bill, or to increase the burden on the people by means of an amendment which must largely increase the amount of money required for the purposes of the bill. I know that it has been explained by the Minister that the money for this and similar purposes does not come from the Consolidated Revenue, but from a special fund already provided for the purpose.
– That is right; it comes out of a trust fund.
– I am doubtful as to the legality of the provision. It is merely a subterfuge, and the Government cannot take money out of a fund which is already exhausted. The Government has already drawn on the Social Welfare Fund to the limit. Although the bill purports to provide the money out of that fund, it must be drawn from the Consolidated Revenue. The proposed new clause therefore cannot be justified.
– According to the honorable senator’s argument, the Government has no right to introduce the bill.
– Probably it has not, but when the bill was introduced the fund may not have been exhausted. However, it is exhausted now. As a matter of fact, we have been told by honorable senators opposite that the bill is only a part of a social service system.
– The honorable senator knows that this will not operate until the end of next year. He need not worry about the money. We have plenty.
– Then what is the hurry for the new clause or for the bill? The Government is in a hurry to give away something which it does not propose to hand out for at least six months or twelve months. The Government has ample time in which to introduce a comprehensive bill providing medical benefits, including those which the Minister is asking for in the proposed new clause.
– I replied to that argument when I stated that there are 2,600 medical practitioners in the fighting force*. To do what the honorable senator suggests would be undesirable.
– To do what the Minister suggests is absurd. He proposes to take power to appoint doctors simply to sign prescriptions, and, as I told him before, the number of doctors required under this proposal would be between 6,000 and 7,000.
– There is not that number in Australia.
– Whether they are in Australia or ‘not, this legislation is to operate not simply for six or twelve months, but for as long as the Labour party can persuade the people that it is rendering them a good service by providing them with these doles. The Minister does not seem to realize that we have a good case. He absolutely deceived the committee at the outset.
– I ask for a withdrawal of the offensive statement that [, a responsible Minister of the Crown, deceived the committee.
– I withdraw the statement. The Minister inadvertently deceived the committee.
– I ask for a withdrawal of the offensive statement that 1 deceived the committee, inadvertently or otherwise.
– I decline to withdraw the statement that the Minister inadvertently deceived the committee, unless you, Mr. Chairman, direct me to do so.
– I ask for the withdrawal of the statement that I inadvertently deceived the committee.
– The Minister for Health (Senator Fraser) objects to Senator Leckie’s statement that he deceived the committee. The Minister has requested a withdrawal of that statement, and I asked that it be withdrawn.
– I did withdraw it.
- Senator Leckie has withdrawn the offensive portion of his statement to which exception has been taken. He qualified the withdrawal by stating that the Minister had inadvertently deceived the committee, but as that implies that the Minister had no intention of being deceitful, I do not think that he is ‘entitled to ask for a further withdrawal.
– As I have said, the views of the committee were !by no means in accord with the explanation of this clause given by the Minister, not voluntarily, but because he has been pressed for an explanation by honorable senators opposite. It is clear _ now that the proposed new clause will enable the introduction of a complete scheme of free medical benefits, without prior consultation with medical men, with the Treasurer, or with Parliament. The relation of this amendment to the measure itself is extraordinary. The cost of the scheme envisaged in the bill is £2,000,000 and now, when the measure is at the committee stage, and half of it has already been agreed to by honorable senators, an attempt is being made to insert an amendment which might involve expenditure amounting to three times the cost of the original scheme. I cannot see any justification for this action. If the Government wishes to introduce a free medical service, it has plenty of time to do so, and it has the numbers to ensure that its legislation shall be passed by Parliament. Such a scheme would receive the sympathetic consideration of honorable senators on this side of the chamber, provided a clear indication were given of how the money to finance the measure was to be provided. The firstessential of any measure such as this should be an appropriation to meet the cost of the legislation. There should be a clear statement of the estimated cost of the scheme and the value of the benefits which it is to confer upon the people, so that these things may be balanced. I cannot understand why the Government has decided to seek the insertion of this clause so late in the consideration of the bill. That is not the way to deal with important legislation. The principle of the bill should come first. It appears now that instead of being merely a cog in the machinery of our social services plan this bill is to be four or five cogs, at least so far as expense is concerned. But the machine cannot keep on working without oil, and, so far, the oil is not present. At least, the National Welfare Fund does not provide it.
.- As the consideration of this measure proceeds, I become more astonished at the conduct of the Minister for Health (Senator Fraser). The least that I expected was that he would give to honorable senators some reasons for his opposition to the amendment that has been moved by Senator Foll; but we have not heard one reason why that amendment should not be accepted by the Government.
– There is no obligation upon the Minister to give reasons where they are not needed1.
– I should not expect a Minister such as the Minister for Aircraft Production (Senator Cameron), who has a great fondness for the ways of dictators, to wish to give any reason for doing anything.
– Order ! The honorable senator must confine his remarks to the subject before the Chair. The Minister for Aircraft Production is not mentioned in this measure.
– The Minister for Health (Senator Fraser), in handling this measure, has displayed precisely the same characteristics. Surely, in dealing with this clause, it is of some relevance to consider the conduct of the Ministerin relation to that clause.
– I have replied three times now, and still the honorable senator is not satisfied.
– My trouble is that the Minister for Health has not touched upon the point at issue at all. As Senator Leckie has said, the implementation of this bill, in its original form, according to the Minister, would cost the taxpayers of this country £2,100,000. Now the Minister has moved an amendment which authorizes him, at his own sweet will, to extend the benefits of this measure to the degree of providing free medical attention for every one who needs medicine.
The Minister cannot deny that. Should this clause become law, the Minister may, if he so desires, extend to every citizen of this country the right to obtain medical services free of cost. There is nothing in the bill to stop that.
– What is wrong with that?
– There would be nothing wrong with it if that were exactly what the clause provided, and it were not left to the Minister to do these things at his discretion. If the Government intends that everybody who requires medical attention shall be able to get it free of cost to the patient, why does it not so -provide in this clause? Let us give to everybody in the community the same right. I wonder what the Minister would say if a government which we supported were to introduce into this Parliament a bill imposing certain taxes, but providing that some taxpayers could be allowed such deductions as the Treasurer thought fit. Would the Minister regard that as a satisfactory piece of legislation? Would he regard it as desirable that the Treasurer should be able to say to one taxpayer, “ I shall allow you a deduction of £50 for your wife “, and to . another, “ I shall not allow you any deduction whatsoever “.
– The honorable senator knows that that is not the intention of this clause.
– On the contrary, that is exactly what this clause sets out to do. It will enable the Minister to extend these benefits to some people and not to others. That is quite clear.
– That is the intention of the clause; that free medical prescriptions should be made available in certain special cases.
– The clause gives to the new dictator of health the authority to decide what the law shall be in relation to the granting of free medical services. This action is absolutely indistinguishable from the methods employed in the dictator countries in Europe. The logical result, of course, is that ultimately the Government will be empowered by regulation to make any law that it desires, in regard to any matter. We might just as well abolish Parliament altogether. We have been given some details in regard to that portion of the measure which will confer upon the people of this country benefits costing £2,000,000 a year. The bill prescribes that certain persons shall receive medical treatment and that others shall not. We are informed that these safeguards have been inserted in the measure to protect the revenue ; but when it is a matter of providing benefits which will cost three times as much as the pharmaceutical benefits, there is no mention of safeguards. If Senator Cooper’s estimate of 20,000,000 prescriptions a year be correct, and assuming that a doctor would not be paid less than 7s. 6d. each time he attended a patient, the cost of this provision would be approximately £7,000,000. Therefore, it would appear that this apparently innocent provision, which, according to the Minister, is designed merely to fill a gap in clause 15, will involve an expenditure of approximately £7,000,000 .per annum. Has the Minister consulted the Treasurer about that? Is he satisfied that there will be £7,000,000 in the National Welfare Fund to cover the cost of the services provided in this measure? I am not, because I believe that all the money in that fund has gone. Having regard to these considerations, I contend that this committee is entitled to some explanation from the Minister as to what he intends to do should this clause become law; whether any limits will be imposed upon the scope of this clause, or whether he insists that he should be given the powers of a dictator to decide that Mrs. Brown of Collingwood shall have medical services free of charge, but that Mr. Smith of Fitzroy shall not. That is the state of affairs which will be created under this clause if it be passed in its present form. I doubt very much whether there has ever been introduced into this Parliament a clause which was more widespread in its operation or more conducive to the destruction of all the principles of democratic government. It hands, over to the Minister the right to declare that some people shall be given free medical services in accordance with a law which he will create from day to day. I do not think that one could find anywhere in Commonwealth legislation anything to equal this, and because of that, I strongly oppose the insertion of the proposed new clause.
– I rise to order. I ask your ruling, Mr. Chairman, as to whether this proposed new clause is relevant to the bill. I draw your attention to Standing Order 187, which states -
The title shall agree with the order of leave, and no clause shall be inserted in any such bill foreign to its title.
– But the Standing Orders have been suspended.
– The only standing orders which have been suspended are those which would prevent the bill being passed through all its stages without delay.
– The honorable senator is delaying it now.
– The suspension of the Standing Orders does not permit of the adoption of a system of tacking. Honorable senators will recall that a long discussion occurred in the Senate some time ago because the Government had attempted to tack on to a bill matters that were extraneous to it, and subsequently the Government had to agree to the demands of the Opposition. The present bill clearly makes provision for the supply of pharmaceutical benefits. The Minister has stated that he will not accept my amendment, which I moved in good faith in order to help him. I ask, Mr. Chairman, if the proposed new clause which introduces the entirely new principle of providing free medical services, is foreign to the title of the bill.
– I rule that the proposed new clause is not foreign to the title of the bill, because the measure is framed to make provision for the supply of pharmaceutical benefits.
– In reply to an interjection by me, the Minister said that the clause was necessary in order to fill a gap, but I think that the amendment proposed by Senator Foll provides all that the Government requires. One can only assume that there is something sinister behind the clause and that the Minister desires to do more than fill that gap. I see no reason why the Government should not accept the amendment. It should not press for a power which is extraordinarily wide. This bill merely makes provision for the supply of pharmaceutical benefits, but, if the proposed new clause were agreed to, it would enable the Minister, at the will of the Government, to enter into a series of agreements from time to time with any medical practitioners who were prepared to provide a socialized medical service. The amendment moved by Senator Foll would provide all that is required to implement clause 15. If itbe not implemented, there will he a reaction to this measure in the country districts similar to that experienced with regard to the National Health and Pensions Insurance Act.
– I regret, Mr. Chairman, that I consider it necessary to dissent from your ruling. I move -
That the ruling of the Chairman be disagreed with.
I shall submit my reasons in writing.
– I shall report dissent from my ruling to the President.
In the Senate:
- Mr. President, I have to report that the committee has been considering clause 15a proposed by the Minister in charge of the bill (Senator Fraser). Senator Foll asked me whether the clause was foreign to the title of the bill, and I ruled that it was within the title of the bill. Senator Foll has moved dissent from my ruling and has submitted the following reasons for his action : -
I disagree with the Chairman’s ruling that clause 15a proposed by the Minister for Health and Minister for Social Services providing for arrangements for the provision of medical services is relevant to a bill to provide for pharmaceutical benefits. I contend that in accordance with Standing Order 187 such clause is foreign to the title of the bill.
I ruled that the clause is in order because it makes provision for the implementation of the bill.
– The new clause, which was suddenly sprung on the committee this afternoon, introduces an entirely new principle. The bill, as introduced last week, makes provision for the supply of pharmaceutical benefits, and the title does not indicate that the measure provides free medical services. I have already pointed out that Standing Order 187 provides that the title shall agree with the order of leave, and no clause shall be inserted in any bill which is foreign to its title. There is nothing in the title of this bill to show that it makes provision for free medical benefits ; the title limits its purpose to the supply of free medicine. Therefore, I contend that the Chairman should not have ruled that the proposed new clause was in order. I suggest that the title of the bill should be amended, or that the clause is out of order, particularly in view of clause 7, which definitely sets out the pharmaceutical benefits to be provided. That clause states -
The pharmaceutical benefits referred to in this act shall consist of -
uncompounded medicines the names of which, and medicinal compounds the formulae of which, are contained in a prescribed formulary to be known as the Commonwealth Pharmaceutical Formulary; and
materials and appliances (not being uncompounded medicines or medicinal compounds) the names of which are contained in a prescribed addendum to the Commonwealth Pharmaceutical Formulary.
In committee I moved an amendment designed to meet the wishes of the Minister, who, in explaining the new clause, said that its object was merely to providefor persons living in isolated areas. Clause 15 provides- (1.) The Minister may make such special arrangements as he thinks fit for the purpose of providing that adequate service in lieu of all or any of the benefits provided for by this act will be available to persons living in isolated areas or under such special conditions that those benefits cannot be efficiently provided in accordance with the general provisions of this act. (2.) Where special arrangements are made in accordance with the last preceding subsection, any provisions of this act inconsistent therewith shall not be applicable in relation to the persons provided for by the special arrangements.
In order to help the Minister, I moved an amendment which would have kept the proposed new clause strictly relevant to the bill, but the Minister rejected it.
The marginal note to the proposed new clause reads, “Arrangements for provision of medical services “. That marginal note contains no reference to free medicine; it embodies an entirely new principle. I contend that as the proposed new clause has no relevance to the bill, or to its title, the Chairman of Committees was wrong in ruling that the clause was in order. I appeal to you, sir, to uphold my objection by ruling that the proposed new clause is not relevant to the bill.
– In supporting the ruling of the Chairman of Committees, I draw attention to chapter XIX.of the Standing Orders of the Senate. It will be seen that Standing Orders 185- 188 relate to the initiation of public bills, and Standing Orders 189-192 to the first reading of such bills. Subsequent standing orders relate to the second reading of bills and to the committal and consideration of bills in committee. My first point is that Standing Order 187 has no applicability to proceedings in committee. Standing Order 201 reads -
Any amendment may be made to any part of the bill, provided the same be relevant to the subject matter of the bill, and be otherwise in conformity with the Rules and Orders of the Senate.
I submit that Senate Foil’s objection must fail, for the reason that I have already given, and also because Standing Order 201 gives to the committee the power to make any amendment at all so long as it is relevant to the subject matter of the bill. As has been pointed out, the full title of the bill is “A bill for an Act to make provision for the Supply of Pharmaceutical Benefits “. The marginal note to clause 15 reads - “ Special arrangements for persons in isolated areas, &c.”. The Minister has moved for the insertion of a new clause with a marginal note which reads, “ Arrangements for provision of medical services “. I suggest that the words “ medical services “ are merely a machinery part of clause 15 and agree with the title of the bill. For the reasons given, I submit that Senator Foil’s point of order cannot be sustained. Standing Order 201 makes ample provision for the proposed new clause which the Minister wishes to insert in the bill.
– The Leader of the Senate (Senator Keane) has paid too little attention to the last words of Standing Order 201, which reads -
Any amendment may be made to any part of the bill, provided the same be relevant to the subject matter of the bill, and be otherwise in conformity with the Rules and Orders of the Senate.
The Rules and Orders of the Senate provide that the title shall agree with the order of leave, and that no clause which is foreign to the title of the bill shall be inserted in any bill.
– This is a different stage.
– It is not. The words in Standing Order 201 are similar to those inStanding Order 187. It would be extraordinary to say that when a bill is initiated clauses which are foreign to its title must not be included, but that such clauses could be inserted at a later stage. I suggest that the concluding words of Standing Order 201 have been deliberately inserted for the purpose of ensuring that the provisions of Standing Order 187 shall be given effect during the passage of the bill through committee. The Minister suggested that there was some association between proposed new clause 15a and clause 15 of the original bill.
– That is definitely so.
– Clause 15 of the bill is limited in its operation to the conferring of the benefits that are provided in the bill. The only benefits that are provided in the bill are the pharmaceutical benefits referred to in clause 7. But clause 15, limited as it is to pharmaceutical benefits, is further limited in that it makes special provision only for people living in isolated areas or under special conditions. That means that it is limited to places where pharmaceutical benefits cannot easily be provided. Surely the proposed new clause is irrelevant to clause 15, seeing that it seeks to confer entirely new benefits. That is to say, it seeks to confer medical benefits, not pharmaceutical benefits, and to extend those benefits, not merely to people in isolated areas or subject to the special conditions referred to in clause 15, but also to any one else in any part of the Commonwealth. It would be difficult to find a provision proposed to he inserted by way of an amendment which had less relevance to or connexion with the original bill than has the proposed new clause.
– The purpose of the proposed new clause is to provide free medical services. I direct attention to clause 15a, which reads -
The Minister may, on behalf of the Commonwealth, enter into an agreement, on such terms as to remuneration, allowances and otherwise a3 he thinks fit, with any practitioner, provided that the services of the medical practitioner shall be available without charge to members of the public for the purpose of giving effect to this Act and furnishing prescriptions to obtain medicine under this Act.
There is nothing there about medical benefits.
– There is.
– The only person who is qualified to write a prescription is a medical practitioner. Before a person is entitled to receive medical benefits under the provisions of this bill he must obtain a prescription from a medical practitioner. I draw attention to the words, “ for the purpose of giving effect to this Act “. Is not the giving of a prescription a service to be paid for? Of course it is.
– No.
– This clause is incidental to the whole of the bill. A person in need of medicine must obtain a prescription, and a medical practitioner is the only person who can provide it. When he has been supplied with a prescription he is able to obtain medicine free from a chemist. There is nothing about calling in a medical practitioner to perform an operation; it says definitely “ for the purpose of . . furnishing prescriptions to obtain medicine under this Act “. The whole purpose of the bill is to provide free medicine.
– The marginal note ‘ to the new clause proposed by the Minister reads, “Arrangements for provision of medical services “. The medical service which will be rendered in this case is the examination of the patient in order to ascertain the treatment that should be given. For that service, fees would have to be paid. I draw attention to clause 16, which authorizes payment “ in respect of pharmaceutical benefits “ from the trust account known as the National Welfare Fund. That is clear. Where does the Government obtain authority to pay for medical services when the bill definitely provides only for pharmaceutical benefits? The bill is clear and definite: it prescribes what the Government shall do, and also for the financing of the specific purposes mentioned in the title of the bill. Money for the purposes set out in clause 16 has to be appropriated. There is no authority in the bill to appropriate money for medical benefits, lt is clear that the benefits for which appropriation of money may be made shall be pharmaceutical benefits, otherwise medicine. The marginal note to the Minister’s proposed new clause refers to medical services. That service is distinct from the provision of medicine. Clause 16 sets out the purpose for which money is to be appropriated under this measure; and to appropriate money under this measure for any purpose other than that for which payment is specifically authorized in the measure is contrary to the Audit Act.
– As Chairman of Committees, I did not give my ruling without careful consideration. At an early stage in the discussion it occurred to me that the proposed new clause had a semblance of irrelevancy. Therefore, I gave the matter serious consideration. It was my responsibility to decide whether the proposed new clause was in order. It was not my responsibility to give a ruling upon the merits of the proposed new clause, or the intention of the Government in submitting it. During the discussion upon the amendment all kinds of fantastic suggestions were made as to the intention of the Government. That aspect had nothing to do with me as Chairman. Senator Foll, in moving his amendment, did not raise the question as to whether the proposed new clause was in order. Had his amendment been agreed to, it would, according to the honorable senator’s own argument, be out of order. I took the view that in order to implement the measure the
Minister might find it necessary to make provision to deal with certain special circumstances. As ‘Chairman I ruled that the proposed new clause was in order.
– We should endeavour to debate this matter without heat, because it is most important that the business of this chamber be carried on strictly in accordance with the terms of its Standing Orders. It is a well-established rule that the object of a bill is always contained in its title. I confess that at first glance the proposed new clause did not appear to me in the light in which I now view it. However, when I was listening to Senator Foll I began to wonder whether it could properly be included in the bill. Clause 1 reads -
This act may be cited as the Pharmaceutical Benefits Act 1944.
That is the short title which we must first consider. It is our guide in the construction of any amendment. Let us suppose that the proposed new clause provided for free legal services. Such a clause would be equally as foreign to the bill as the proposed new clause which provides for free medical services. The bill deals with pharmaceutical benefits. Indeed, it was criticized on the ground that it made no provision for medical benefits; and in answer to that objection we were told that free medical services would be provided later. The Government has decided upon the provisions necessary to make available pharmaceutical benefits to the people of this country free of charge under certain conditions. Therefore,, to superimpose on such a measure a provision for free’ medical services is entirely foreign to the bill. If the title of the” bill included medical benefits as well as pharmaceutical benefits the present difference of opinion could not arise. However, the Minister stated during the second-reading debate that the provision of medical benefits would be a matter for subsequent consideration by the Government. The difficulties which confront the Government in the provision of medical benefits as well as pharmaceutical benefits has no bearing on the question as to whether the proposed new clause is in order. Standing Order 201 provides -
Any amendment may be made to any part of the bin provided the same be relevant to the subject-matter of the bill. . . .
What is the subject-matter of this bill - not medical advice, but medicine. The subject-matter of the bill is set out in the bill itself, and no argument can destroy the effect of its short title. It is open to the Government to provide benefits in addition to pharmaceutical benefits in any other way that it might deem fit; but let us have this matter, at all events, decided in conformity with the Standing Orders. It is most objectionable and confusing to include in one measure something entirely foreign to the object of the measure as disclosed in its title. Evidently, the draftsman, in drafting the proposed new clause, had a feeling that he was doing something irregular; and, apparently, he saw the point that is now being taken. I have no doubt that the draftsman is familiar with the Standing Orders of the Senate. In his dilemma he added to the proposed new clause the words, “ for the purpose of … . furnishing prescriptions to obtain medicine under this act”. The substance of the proposed new clause is that medical men may be employed and paid for a certain purpose, and, as Senator Herbert Hays has pointed out, I do not know under what authority money can be paid for that purpose. That is a sound criticism. The bill provides for pharmaceutical benefits, but makes no provision for medical attention. That, of course, is one of the Government’s difficulties, but it can overcome that difficulty without overriding the Standing Orders of the Senate.
– I speak with diffidence on this matter, because I do not possess legal training. I support the ruling given by the Chairman of Committees. The framers of the Standing Orders must have had a definite objective in mind when they set out the Standing Orders in watertight compartments. Standing Order 201 reads -
Any amendment may be made to any part of the bill, provided the same be relevant to the subject-matter of the bill, and be otherwise in conformity with the Rules and Orders of the Senate.
I submit that the amendment proposed by the Minister is relevant to the title of the bill. The proposed new clause reads -
The Minister may, on behalf of the Commonwealth, enter into an agreement (on such terms as to remuneration, allowances and otherwise as he thinks fit) with any medical practitioner provided that the services of the medical practitioner shall be available without charge to the members of the public for the purpose of furnishing prescriptions and orders for the purposes of this act.
The purpose of the proposed new clause is to permit free medical treatment in certain circumstances. Therefore, it conforms with the title of the bill. Clause 7 6 of the bill reads -
The pharmaceutical benefits referred to in this Act shall consist of -
Materials and appliances (not being uncompounded medicines or medicinal compounds) the names of which are contained in a prescribed addendum to the Commonwealth Pharmaceutical Formulary.
Honorable senators have already agreed to that clause. I submit that if the proposed new clause is ultra vires the title, paragraph b of clause 7 must also be in the same category. Clause 13 (3) reads -
The regulations may provide that an approved hospital authority shall be entitled to payment from the Commonwealth at the prescribed rates in respect of the supply of prescribed uncompounded medicines, medicinal compounds, medicinal appliances which are not pharmaceutical benefits..
I am not a lawyer, but, in view of the arguments adduced, I support the Chairman’s ruling.
– The argument is interesting, and should not cause any heat. There are all sorts of precedents and standing orders bearing on this subject. We brought the Standing Orders up to date in 1937, when I was Chairman of Committees. The Leader of the Senate (Senator Keane) referred to the different stages at which bills can be debated and argued that Standing Order 187 was not applicable in this case. I remind him that the title usually remains unaltered. I submit that Standing Order 187 applies, and that the proposed new clause is foreign to the title of the bill. Standing Order 187 is explicit, as also is Standing Order 201, which the Leader of the Senate quoted, as did other honorable senators. The concluding words of Standing Order 201 “and be otherwise in conformity with the Rules and Orders of the Senate” are particularly clear. We base our objection on Standing Order 187, and submit that the point of order should be sustained.
– Standing Order 187 provides -
The title shall agree with the order of leave, and no clause shall be inserted in any such bill foreign to its title.
Every bill that comes before the Senate must pass through its various stages and every honorable senator has the right to speak on all measures. When a bill is in committee it is taken clause by clause. The last question which the Chairman puts is : “ That the title be the title of the bill “. If there is anything in the bill which is irrelevant to the title, the title must be amended. In this case there is no relevancy between the proposed new clause and clause 15, which makes no reference to medical practitioners. Proposed new clause 15a provides -
The Minister may on behalf of the Commonwealth enter into an agreement . . . with any medical practitioner.
– For what purpose? As a medium to prescribe medicine under the bill.
– The proposed new clause relates to medical practitioners whereas the bill deals with pharmaceutical benefits. Clause 16 provides -
Payments in respect of pharmaceutical benefits shall be made out of the Trust Account established under the National Welfare Fund Act and known as the National Welfare Fund.
That deals with pharmaceutical benefits, and “ medical practitioner “ is not mentioned. If the services of a doctor are required, by what authority does the Government raise the money to pay him ? A careful study of clause 15, to which proposed new clause 15a is related, and also of Standing Order 187, shows that the proposed new clause is foreign to the title of the bill. Its purpose is not mentioned in any other part of the bill.
– “ Medical practitioner “ is mentioned in clauses 9 and 13.
– He is not included in any clause which relates to the payment of fees. Standing Order 201 should convince you, Mr. President, that no amendment may be made to any part of the bill unless it is relevant to the subject-matter of the bill, and otherwise in conformity with the Rules and Orders of the Senate. I shall be glad to hear how the proposed new clause is relevant to the title.
– No honorable senator has mentioned Standing Order 206, which provides -
If any amendment shall have been made in the bill, not coming within the original title, such title shall be amended and a question put “ that this be the title of the bill “, and the amendment thereof shall be specially reported to the Senate.
The Leader of the Senate (Senator Keane) pointed out that the section of the Standing Orders of which Standing Order 206 forms a part is headed, “ Committal and Consideration in Committee “. It is, therefore, quite competent for the committee if an amendment has been made which does not come within the title of the bill, to alter the title accordingly.
On consulting the dictionary I find that “pharmaceutical” means “pertaining to, using, or relating to pharmacy”. “ Pharmacy “ means-
The art or business of compounding preserving and identifying drugs, and of compounding and dispensing medicines.
The proposed new clause provides -
The Minister may on behalf of the Commonwealth enter into an agreement . . . with any medical practitioner providing that the services of the medical practitioner shall be available without charge to members of the public for the purpose of furnishing prescriptions and orders for the purposes of this act.
It has been argued that the marginal note “arrangements for provision of medical services “ must be taken into consideration. The definition which I have quoted refers to the compounding of medicines. If for certain reasons of which I am unaware the Government is anxious to make the services of a medical practitioner available for the purpose of furnishing medical prescriptions, it appears to me that there is a close relation between the title of the bill and the purpose of the clause as expressed inthe marginal note which I have quoted. Senator A. J. McLachlan spoke of the provision of free legal services. That would not be germane to the title of the bill. A medical practitioner who supplies a prescription to be used to pro cure certain drugs becomes very closely associated with the object of the bill which is to provide pharmaceutical benefits. I understand that medicines or drugs cannot be obtained under the bill without the prescription of a medical practitioner, and the proposed new clause provides that in certain circumstances a medical practitioner shall be made available without charge for the purpose of furnishing prescriptions. The relevancy of the two provisions is very clear to me. In some circumstances a fee will have to be paid to the medical practitioner, but in others the Government is making provision for his services to be furnished free. The title of the bill and the proposed new clause appear to be closely related.
– How does Standing Order 206 operate in view of Standing Order 187? Does it override it?
– Standing Order 187 provides-
The title shall agree with the order of leave, and no clause shall be inserted in any such bill foreign to its title.
In the committtee stage, it is competent for the committee, under Standing Order 206, to alter the title in consonance with any amendment which may have been made to the bill in committee. I therefore uphold the ruling of the Chairman of. Committees.
In committee:
Consideration resumed (vide page 806).
New clause 15a (vide page 791).
Question put -
That the words proposed to be inserted (Senator Foll’s amendment- vide page 707) be inserted.
The committee divided. (The Chairman - Senator Courtice.)
AYES: 17
NOES: 18
Majority . . . . 1
AYES
NOES
Question’ so resolved in the negative.
Amendment negatived..
New clause agreed to.
Clause 16 (Payment of benefits tobe made from National Welfare Fund).
– This clause is similar to one which was included in another social service measure which was passed by the Senate last week. The clause reads -
I reiterate my opposition to this principle of financing social service legislation, and I trust that the Government will not use its majority in this Parliament to inflict upon the people of this country a scheme which must finally collapse under its own weight. I realize that the Opposition is unable to defeat this clause, and I know that caucus rule is so strong amongst honorable senators opposite that no Government supporter is permitted to use his own intelligence and to vote according to his opinion. It is opportune that I should quote a recent utterance by the British Prime Minister, Mr. Churchill -
We must beware of trying to build a society in which nobody counts for anything except a politician and an official; a society where enterprise gains no reward and thrift no privileges.
The Opposition has always held the view that, there should be a comprehensive insurance scheme to cover measures such as this, and I regret that the Government is being so pig-headed as to continue in its endeavours to fulfil its election promises, and to pander to its political supporters.
Clause agreed to.
Clause 17 agreed to.
SenatorSpicer. - Mr. Chairman, I rose to speak on clause 17.
– That clause has been agreed to.
– Surely honorable senators on this side of the chamber have some rights!
– Order !
.- Senator Spicer rose before the question was put. He is entitled to speak on clause 17. Since when has the Chairman of Committees had the right to wield a bludgeon over honorable senators upon this side of the chamber? No wonder people outside of Parliament are crying out for freedom of speech; there is not freedom of speech even in Parliament.
– Order ! The honorable senator must resume his seat. Senator Spicer had ample time to secure the call when I was putting the clause to the committee.
Clause 18-
For the purposes of this act there shall be a Formulary Committee consisting of six persons appointed by the Minister.
.- I have the same objection to this clause as I have to clause 17. Both these clauses are meaningless. What is a “ formulary committee “ ? What will be its functions? I have been unable to find anywhere in the bill a provision stating what the formulary committee is to do and unless the functions of that committee be prescribed in the measure, it cannot legally do anything. The same applies to the consultative council. This is no mere technicality; it is a reality. Usually when a bill provides that a committee shall be formed, it also sets out what the committee is to do. This clause does not even indicate what is meant by a “ formulary committee “, and moreover it makesno mention of the persons to be appointed to that body. Even when the Women’s Employment Board was created by regulation, it was provided in that regulation that that board should be composed of certain classes of people.
– Is that not covered by clause 26 d?
– If the Minister for Health has to provide for all these things by regulation, we are reaching a pretty pass.
– It is the new order.
– I am afraid that it is typical of the new order which we must expect from this Ministry. It is deplorable that Parliament should be asked to agree to meaningless words such as these. The Government in effect says, “You can have a committee, but we shall not tell you what the committee will do; the Minister will prescribe that by regulation”. The formulary committee must of necessity be a technical body, and it would be very improper to appoint unqualified persons to that committee. Surely one is entitled to expect to see the qualifications of the people who are to serve on that committee specified in the bill ? I expected the Minister to provide that the committee be composed of say three medical men and three pharmacists. Whom does the Minister propose to appoint to ‘this committee? Why not let us all into the secret? If the Minister told honorable senators what kind of individuals were to be appointed to this committee we should be greatly assisted in our consideration of the measure.
– I move -
That, after the word “ Minister “, the following words be added : - “ of whom two shall be practising medical practitioners, two shall be practising pharmaceutical chemists, and one shall be a pharmacologist”.
It is essential that those who are to prepare the formulas for the medicines shall have the highest qualifications for that task. If my amendment be accepted, it will not interfere in any way with the operation of the scheme, but will merely require that the persons appointed to the committee shall be experts, well capable of determining which medicines are beneficialand which are not. The committee would include two medical practitioners, who, through daily contact with their patients, would be well able to prescribe the necessary medicines; two chemists, whose training qualifies them to determine matters relating to the dispensing of pharmaceutical preparations; and one member who would be a pharmacologist, that is, a person who understands the science of drugs.
SenatorFRASER (Western Australia - Minister for Health and Minister for Social Services) [9.47]. - I have no objection to the amendment, but I point out that it may be difficult to induce a pharmacologist to agree to become a member of the formulary committee.
– I am prepared to assist the Minister by including the words “if available “ in my amendment. The addition I wish to make would then read - of whom two shall be practising medical practitioners, two shall be practising pharmaceutical chemists, and one, if available, shall be a pharmacologist.
SenatorFraser. - I shall accept that.
.- It seems to me that the amendment does not meet the needs of the case. The committee is expected to draw up the formulary, but the experts who know best what drugs should be provided for particularcures are the doctors. The chemists merely dispense the medicines prescribed by the doctors. There should be at least four, if not five, medical practitioners on the committee. The Minister should recognize that the amendment does not go far enough.
Amendment, as amended, agreed to.
Clause, as amended, agreed to.
Clause 19 (Pharmaceutical Benefits Committee).
– What are to be the qualifications of the members of this committee, and how are they to be chosen ? . Will they be appointed by the Minister, or chosen by an authority in each of the States.
– A pharmaceutical benefits committee is to be appointed in each State, and the members of these committees need only be chemists. I suppose that they will be chosen in the same way as the members of the formulary committee. I have asked the British Medical Association to submit a panel of names of medical men willing to serve on that committee. The friendly societies. of course, have a responsibility to their members. This clause really provides for the appointment of disputes committees no act between the public and the chemists.
– I ask the Minister to provide for the inclusion of a representative of the friendly societies’ dispensaries, so that those bodies shall not be left to the mercy of the other chemists when a determination is made as to whether they shall be represented on the committees. The Government has paid “a tribute to the work of the friendly societies, and recognition of the value of their services should be shown by giving them representation on these committees.
– The honorable senator’s remarks in that regard will not be overlooked.
Clause agreed to.
Clauses 20 to 22 agreed to.
Clause 23 (Consent to prosecution).
.- I protest against this clause, which gives to the Minister the right to determine, whether a person supposed to have committed an offence under the act shall be prosecuted. That matter should be left in the hands of the director-general. If a person has committed an offence against an act, the question whether he should be prosecuted should be kept as far away as possible from the political head of a government department. Clause agreed to.
Clauses 24 and 25 agreed to.
Clause 26 (Regulations).
– This clause contains the usual provision that the Governor-General may make regulations not inconsistent with the act, and, in particular, for the purposes set out in paragraphs a to e. We should clearly state in the bill all of the things which may or may not be done, but we are asked to agree to skeleton legislation, with a provision at the end of the bill, in the widest possible terms for “ grab all “ regulations. It is a dangerous practice to provide for the matters to be covered by the bill and then for the. Governor-General in Council to make regulations setting out all sorts of things which may be prescribed. In addition to making regulations of a general nature, the Governor-General may also make particular regulations. These are set out in paragraphs a to e. From time to time, attention has been drawn to the increasing tendency to legislate by means of regulations. Government by regulation may make the administration of legislation easier for government departments, but it increases the difficulties of those in the community who have to comply with the law. The practice should be discouraged. The Parliament should set out clearly in the legislation that it passes what is intended, so that all the people may know what is required of them. That, I submit, is a proper function of the Parliament. Frequently, however, the Parliament passes what is merely a skeleton bill, leaving all the administrative details to be governed by regulations. In my judgment, that system is bad; it lends itself to abuse, and adds to the difficulties of innocent people who may unwittingly commit a breach of the law, seeing that regulations have the effect of law. From time to time, the validity of regulations may be in doubt, but less notice is taken of them than of the act under which they are made, with the result that frequently regulations containing provisions which would not be acceptable to the Parliament had they been embodied in the measure are given the effect of law.
– 1 should like the Minister for Health and Social Services (Senator Fraser) to say what is envisaged in paragraph a of clause 26, which reads -
Prescribing the terras and conditions subject to which pharmaceutical benefits shall be supplied.
I understood that the purpose of this legislation was to .provide pharmaceutical benefits for every person in the community subject only to the production of a doctor’s certificate, but this paragraph causes me to wonder whether that is the intention. It authorizes the Minister to say that pharmaceutical benefits may be provided only if certain conditions .be complied with. Clause 8 provides that “every person ordinarily resident in the Commonwealth shall be entitled to receive pharmaceutical benefits “. Those words are preceded by the words : “ Subject to this Act “. What is to prevent the Minister from prescribing terms and conditions which limit the right of certain persons to receive pharmaceutical benefits on the ground that they are not entitled to them because their rights are “ subject to this act “. Is that the intention, or has this clause some other purpose?
.- Clause 26 a refers to the. conditions upon which regulations will be promulgated.
– No. Paragraph a provides that the regulations may prescribe the terms and conditions subject to which pharmaceutical benefits shall be. supplied. There must be a prescribed form. That is in the bill.
– Yes. The paragraph covers such matters as the hours during which medicines may be obtained. There may be an additional fee for medicine obtained after the regular trading hours.
– Is not the medicine to be supplied free?
– There will be certain hours of trading, and for medicine supplied outside those hours a charge may be authorized. These and other matters come within the scope of paragraph a. Honorable senators know that it is impossible for any legislation to provide for every detail of administration, and consequently the power to make regulations is necessary. That has been the practice for many years.
Clause agreed to.
Postponed clause 3 -
The Governor-General may, by proclamation, declare that this Act shall not have effect in any part of the Commonwealth specified in the proclamation and, so long as the proclamation continues in force, this act shall not have effect in that part.
SenatorFRASER (Western Australia - Minister for Health and Minister for Social Services) [10.10]. - I have endeavoured to meet the wishes of the Opposition in regard to this clause. Accordingly, I move -
That, after the words “ in the proclamation “, the following words be inserted:-“ (being a part of the Commonwealth to which the National Security (Emergency Control) Regulations apply) . “ “
Amendment agreed to.
Clause, asamended, agreed to.
Title agreed to.
Bill reported with amendments; report adopted.
Thirdreading.
Motion (by SenatorFraser) proposed -
That the bill be now read a third time.
.- During the second-reading debate, and also in the committee stage, some extraordinary revelations were made by honorable senators on the Government side of the chamber as to their plans in respect of future bills to give effect to the Government’s policy in connexion with social legislation. One matter which gives me a great deal of concern is the admission by the Minister for Aircraft Production (Senator Cameron) and Senator Large that, in their opinion, the day of the friendly societies in Australia had passed.
– I did not say that.
– The honorable senator said that the day of the friendly societies in Australia was coming to an end.
– I rise to a point of order. It is not true that I said that the day of the friendly societies has passed, and I ask that the statement be withdrawn.
– There is no point of order. Should the Minister believe that he has been misrepresented, he may make a personal explanation when Senator Foll has finished speaking.
– The remarks of Senator Foll are offensive to me inasmuch as they are not true.
– When an honorable senator asks for the withdrawal of words used by another honorable senator on the ground that they are offensive to him, the honorable senator using such words may be called upon to withdraw them. The Minister for Aircraft Production (Senator Cameron) says that certain words used by Senator Foll are offensive to him. I ask Senator Foll to withdraw those words.
– As I have not said
May thing which I regard as being offensive to the Minister, I decline to withdraw any remarks which I have made. At least two honorable senators opposite declared that the work now being done by the friendly societies in Australia was drawing ,to a close. They paid tribute to the work performed by those societies, but said that they had performed certain functions which in future were to be carried out by the Government. In my view, nothing more disastrous could happen in this country. As Senator Large pointed out, the total number of subscribers to friendly societies in this country is approximately 700,000. As the families and relatives of those subscribers participate in the benefits provided by friendly societies, we can say that over 2,000,000 people in Australia are interested in those, societies. The Minister for Aircraft Production, in the course of his second-reading speech,, wholeheartedly condemned the thrift of the Australian people as exemplified in their contributions to friendly societies. His condemnation was so vehement that I have received a letter from the secretary of the Hibernian Australasian Catholic Benefit Society strongly protesting against the Minister’s remarks. The thrift exemplified by membership of friendly societies is a most commendable characteristic of our people.
– Is the honorable senator a member of a friendly society?
– I have been a member of a friendly society for many years. It will be a sad day for this country when the work now being performed by those societies comes to an end as the result of the passage of measures of this kind. The foundation of that work is the thrift of hundreds of thousands of our people, and it is of outstanding credit to this nation. Only yesterday I received the annual report of the Metropolitan Hospitals Contribution Fund of New South Wales, the director of which is my personal friend. That report reveals that in the City of Sydney alone approximately 400,000 people subscribe weekly amounts ranging from 6d. upwards in order to obtain hospital benefits. Those facts show that the great majority of the people of Australia do not want legislation along the lines of this measure. They do not want doles from the Government. Only last year the director of the Metropolitan Hospitals Contribution Fund of New South Wales obtained permission from the Treasurer (Mr. Chifley) to organize’ industrial groups in various Commonwealth departments in connexion with the fund. He met with such a response that to-day a Public Service group exists in every area in which the organization operates. It is clear that the great majority of Australians prefer to make provision in their own way for benefits of this kind rather than rely upon any government to come to their assistance. Further evidence of the thrift of our people is the fact that millions subscribe to mutual life assurance companies and building societies. That shows that they do not want cheap referendum baits of the kind provided in the measure now before us. Such measures do not reflect credit upon this Government. Let us recall for a moment the character of the pioneers who blazed the trail in this country, fighting drought, fire and flood. Did they look for free bottles of medicine from the Government? Legislation of this kind is not worthy of their descendants. Therefore, I protest against statements by honorable senators opposite that friendly societies have served their purpose and are now to make way for a Santa Claus government which will provide the wants of the people. I have been a member of this Parliament for 27 years, but not one of the electors of Queensland has at any time asked me to endeavour to get something for him for nothing. All that our people want from the Government is an opportunity to work in order that they can earn sufficient to provide for themselves and their families. This measure does not reflect credit upon the Parliament or the Government. It will not be welcomed by the great majority of our people. Through friendly societies, insurance companies and building societies, our people prefer to make provision for themselves, and do not want aid from a Santa Claus government. Measures of this kind should make the Government hide its head in shame.
– f have no objection to an honorable senator imputing ulterior motives to me because of some remark I have made provided that he quotes the exact words I used. However, Senator Foll, rather than consult the records of the Senate to ascertain what I did say, deliberately attributed to me words which I did- not use. In societies not so respectable as ours, persons who do that sort of thing are classified in an undesirable category. I referred to the work of friendly societies simply in order to point out the limitations of those organizations. I defy any honorable senator to deny that those limitations exist. I said that it was evident that any friendly society which possessed accumulated funds had not paid out in benefits an amount equal to the total contributions it had received from its members. The following letter which is addressed to the Prime Minister (Mr. Curtin) gives some indication of the limitations of friendly societies : -
I read a statement by Sir Earle Page that friendly societies had done and were doing a wonderful job.
I am a member of the Druids Lodge in Tasmania with 40 years standing, joined at the age of sixteen years. I claim I am able to speak from experience, am certain they are performing a very poor effort. Now let us examine the friendly societies.
No. 1. - A citizen wishing to join a lodge must pass a medical examination to declare their health in sound condition, or otherwise they cannot become a member. The poor fellow who is unfit is passed out. What is to become of him?
No. 2. - The lodge regulations state you can have the doctor and chemist in your district. If the doctor does not understand your ailment, you have to pay for advice from another doctor. If pills, ointments, plasters, or any extra medicines have to be supplied by chemists you have to pay for them. A member of our lodge in my case if falling sick would receive £1 per week for 20 weeks, 10s. for thirteen weeks, and 5s. per week for two years. We are entitled to £100 at death. But if a member becomes unfinancial due to three years sickness, as just stated, he loses his status and dies, after a lapse of a month, he is not entitled to any benefits in my case. I have been financial for 40 years. When I joined the lodge it had a regulation, cease to pay at fi5 years on full benefits, but that regulation does not exist now. The lodges have thousands of pounds invested.
I am firmly convinced that social security is the only method whereby people could get hospital treatment free, &c. A man from here is paying £2 2s. per visit to the doctor in Melbourne; a pretty tall order for a working man.
If the Government were to take over all moneys of lodges, that is after the bill is through, there could be some way of making it a contribution from each member of the lodges towards the social security scheme, which would help it to start off; and if a small contribution were made by every individual the Opposition would have no grouch coming.
I hope this explanation about friendly societies will be of some assistance. It might be said, why am I a member of a lodge? Well it is the best proposition offering under our system which is a very poor proposition.
The writer, states, in effect, that up to a point, as I should assume, the friendly societies have done useful work. Senator Large said that the time had arrived when better work must be done, lt is obvious that the societies cannot provide for all the men and women requiring medical advice or pharmaceutical benefits. The Labour party has therefore brought forward a scheme, which does not mean that the friendly societies are to be put out of existence, lt seems to me that Senator Foll, misrepresenting the whole position, ignores the fact that the Government can make use of the machinery of the friendly societies. They and their members will be much better off working in cooperation with the Government, in exactly the same way as the Government is making use of the machinery of the private establishments conducted by chemists. The chemist becomes part and parcel of the machinery of the Government for social security purposes, and the dispensaries and other services which the friendly societies provide can perform similar functions. The statement that Senator Large and I had said that the purpose of the bill is to abolish the friendly societies is deliberately untrue, as the honorable senator who made it should know.
I have no apology to offer for what I said about thrift. It was, in effect, that thrift carried to the extreme becomes a vice, inasmuch as it enables militarists and others, as has been proved in the Axis countries, to appropriate all the wealth that the people have accumulated “in excess of what they need to live on. If a people is prepared to live on a rice ration its rulers have much more wealth at their disposal than would be the case in a country like Australia, whose standard of living is higher. To that extent thrift is a vice. If, for example, the majority of the people of Germany,. Italy and Japan determined that all the wealth produced by their labour must be used for their own benefit, in building model homes, expanding and improving social security, as we are doing to-day in Australia, and putting in hand national undertakings of all kinds, there would be no wealth left there for military purposes. If those people were not so thrifty and easily imposed upon,, as we should be imposed upon by honorable senators opposite if they had the power, the possibilities are that we should never have another war.
– Order ! The honorable senator must confine his remarks to the bill.
– Senator Foll said that the people did not want this kind of legislation. The principle upon which Labour’s policy is based is full freedom of access for the people to the means by which they live. This is just a small measure of that freedom, and represents a small effort to break down the restrictions that stand between the people and the means by which they live. Before the present Government came into power, when I was privileged to speak in this Parliament for the first time, I directed attention to the fact that the means by which the people lived were restricted, in the case of hundreds of thousands of them, in the form of a dole. The position is much better to-day, and we nope that it will become better still, since the whole aim of Labour’s legislation ‘is to break down and remove all such restrictions, including the present wage system itself. When Senator Foll, becoming hysterical, indulges in deliberate misrepresentation, it is our duty to correct him. We have the very best of reasons, which will stand any test and investigation, for submitting the legislation that has been put before the Senate in the form of this bill, the Unemployment and Sickness Benefits Bill, and social security measures generally. Further, our policy is one which is now being adopted in overseas countries, partly as the result of the war, and partly because it has been proved beyond all doubt, as I said in my second-reading speech, that the greatest asset of a nation is its virile and well.caredfor men, women and children. All other assets, such as gold, timber and land, are minor by comparison. Our greatest asset is, as I say, a virile wellearedfor community, and the legislation which we are passing is a step towards attaining that objective.
– I understand that in my absence I was attacked.
– The honorable senator was not attacked.
– I heard sufficient to realize that a false construction was placed on what I said. It was said that I claimed that we were going to wipe the friendly societies out of existence by means of this bill. That is definitely a false construction of what I said.
– The honorable senator was not misrepresented. He himself said that the friendly societies would cease to operate in twenty years’ time.
– Earlier in the day Senator Foll announced that he intended to raise the tone of the debate. In my estimation, his conception of raising the tone of the debate is a very poor one. Although I know that he believes in private enterprise, and disapproves of governmental or socialist schemes, I did not think that he would stoop so low as to misconstrue what an opponent had said in order to score a point in debate.
– I did not misconstrue anything that the honorable senator said. If the honorable senator had been here, he would know that I said that he had stated that this legislation would eventually be the means of the friendly societies going out of existence probably in twenty years’ time.
– I did say that the bill would mean the Government taking over the responsibility for the health of the people - a responsibility which should have been assumed by the party opposite many years ago. I praised the friendly societies, which I said had done a noble job, but I added that they had fulfilled their function and that there would be, in my estimation, a transition period of twenty years before they finally ceased to operate. The sentiments which I expressed have since been endorsed by prominent officials of the societies, who agree with me in every essential, except that some think it may be 25 or even 30 years before they cease to function. Their central council carried a resolution in support of this legislation, and said that it would not in any way interfere with anything which was constructive or made for progress. Honorable senators opposite are against progress. If they were allowed to do so, they would breed a mendicant race. They believe in a subservient populace, and in charity. We do not stand for doles, or charity. In order to avoid a repetition of what occurred some years ago, we have introduced this social welfare legislation. One of its purposes is to enable the workers to hold up their heads, look all men in the face, and feel that they live as a right and not as a charity: I have used the term “flatearthers “. We have got beyond the stage of flat-earth men, who are afraid of progress. We must move with the times. Conditions are changing rapidly, and we must adapt ourselves to them. No matter how sincere or earnest the members of the Opposition may believe themselves to be in their views on this subject, I am sure that before long they will realize that the policy of socialism, which they have hitherto reviled, is the only one to suit the people. Although at present they are conservative in the extreme, I hope that soon theywill see the light. I was greatly disappointed to hear that I had been attacked and misquoted in my absence.
– The honorable senator was not attacked or misquoted.
– I could say quite a lot more about the attitude of certain honorable senators opposite towards progress generally, but I shall save that for other occasions.
Question resolved in the affirmative.
Bill read a third time.
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Hospital Expenditure in New South Wales.
Motion (by Senator Keane) proposed -
That the Senate do now adjourn.
– I draw attention to an item which was included in the State news shortly after 7 o’clock this evening. It was announced that the McKell Government had to-day voted £70,000 towards the upkeep of New South Wales hospitals. That sum is supplementary to the larger amount of £258,000 which was voted by the Government last year for this purpose. The State taxpayers who have had to provide these sums are also Commonwealth taxpayers, thus demonstrating the necessity for the measure which the Senate was discussing earlier to-night. All that money is necessary to maintain the hospitals.
Question resolved in the affirmative.
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The following papers were pre sented : -
Defence Act - Regulations - Statutory Rules 1844, No. 39.
Defence Act and Naval Defence Act - Regulations - Statutory Rules 1944, No. 37.
National Security Act - Regulations- Statutory Rules 1944, Nos. 36, 38, 40, 41.
Senate adjourned at 10.46 p.m.
Cite as: Australia, Senate, Debates, 2 March 1944, viewed 22 October 2017, <http://historichansard.net/senate/1944/19440302_senate_17_177/>.