27th Parliament · 2nd Session
The PRESIDENT (Senator the Hon. Sir Alister McM,Min) took the chair at 2 p.m., and read prayers.
– Is the Leader of the Government in the Senate aware that the President of the Australian Council of Trade Unions, Mr Hawke, has written to the Prime Minister seeking 4 weeks annual leave for Commonwealth public servants? In view of the importance and urgency of this matter to so many Commonwealth public servants can the Minister secure information on it? How long will the Government take to make a decision?
– I did see a Press report to the effect that the honourable senator has indicated. As for commenting upon it, I think that the proper thing to do is for the honourable senator to put his question on notice.
– 1 direct a question to the Acting Minister for Immigration. In view of the changing status of Fiji will the Australian Department of Immigration be adjusting its thinking as regards applications from citizens of Fiji for permanent Australian citizenship?
– In the absence of the Minister for Immigration 1 think I should ask the honourable senator to put this question on the notice paper so that I can obtain the information for him.
– I ask the Leader of the Government in the Senate whether his attention has been directed to a statement by Mrs Gwen Benzie, Secretary of the Australian Women’s Basketball Association, in today’s Melbourne ‘Age’ in which she is reported to have said: lt was understood but nol specifically mentioned that no team of coloured players would go to South Africa.
She was referring to the fact that South Africa is a member of the International
Federation of Women’s Basketball and Netball Associations and that this condition of entry to South Africa, while not being specific, was well known to all members of the Federation. Does not this attitude of the South African Government reflect the direct interference in sport on racial grounds which the Minister condemned in the Senate yesterday?
– I have not had the advantage of seeing the article, apparently in today’s Melbourne ‘Age’., to which the honourable senator has referred. I will take the opportunity to look at it later in the afternoon. I do not depart from my very brief observation of yesterday. lt reflected a personal belief which I have always held. I believe that sport is for sportsmen and politics for politicians. 1 have always held the view - it is a personal view and I do not shrink from it - that it would be a sad day when politics was allowed to intrude into sport. 1 am a lilywhite so far as sports are concerned. I do not believe in professional sport. 1 believe in sport for sport’s sake. As to the rest of the question I will, as f have said, seek the article to which the honourable senator has referred and read it.
– 1 wish to direct a question to the Minister for Air. ls he aware that the Deputy Leader of the Opposition claimed in a television interview recently that the Fill aircraft needed tanker refuelling in the air equally as much as the F4 aircraft and consequently both aircraft needed aerial tanker support? As the Deputy Leader of the Opposition claims to be an authority on such matters, I ask: Will it be necessary for the FI 1 1 to have tanker support to meet the operational requirements of the Royal Australian Air Force?
– The Deputy Leader of the Opposition in which House?
– The Deputy Leader of the Opposition in the other place.
Royal Australian Air Force firmly believes that a strike and reconnaissance capability is an essential element in a balanced defence force.
– It is wrong in every other belief. Why should it be right in this one?
Please wait a minute. I repeat that it is an essential element in a balanced defence force in Australia. The RAAF firmly believes that this capability is to be found in the FI 1 1 aircraft. One of its reasons for this belief is the fact that the Fill does not need to be refuelled in the air.
– My question is directed to the Minister for Supply. It refers to the Minister’s announcement on 17th May that 3 sub-contracts in relation io the jumbo jet aircraft have been obtained by the Australian aircraft industry to a total value of $A500,000. I ask: Are these orders related only to the orders placed by Australian operators with the Boeing company? Do they comprise a final allotment to Australia of sub-contracting work? Can the Minister explain why the Government Aircraft Factories have been given the smallest sub-contracting order of the three?
– The answer to the honourable senator’s question is, of course, that this matter was touched off, shall we say, by the acquisition of Boeing aircraft by Australian operators. The principle which was originally enunciated by Sir Allen Fairhall when he was Minister for Defence was that a very real look should be had at the possibility of turnback orders for the Australian aircraft industry, lt will be recalled that a delegation of Australian industrialists went to the United States of America for the purpose of propounding this principle. In the event representatives of the Boeing company came to Australia and I and departmental officers had interviews with them. The representatives of Boeing visited the various factories and a number of packages was made up. The representatives said that they believed that, within their requirements, there would be a possibility for the Australian industry to tender for sub-contract work.
Boeing has now accepted tenders for subcontract work in the order of SUS750.000 from 3 Australian organisations. Hawker de Havilland Pty Ltd will supply escape slide containers to the value of
SUS450.000. The Commonwealth Aircraft Corporation Pty Ltd will supply gear boxes to the value of SUS200.000. The Government Aircraft Factories will supply 2,500 aircraft windows worth approximately SUS1 35,000. I do not think that there is any significance in the different amounts of the sub-contracts. Boeing’s requirement was the main factor. Boeing is producing an aircraft. It believed that it can get tenders for certain sub-contract work in Australia. There would not be any differentiation between the various companies which tendered for this work.
I am sure that nobody would like to think that this is the end of the road. As I said yesterday, it is a modest beginning, but I hope that it will be clear in future, whenever we let contracts overseas for sophisticated equipment which it is not appropriate for us to produce ourselves, that we shall be looking for sub-contracting work for the Australian industry wherever possible. I agree with Senator Bishop’s approach that we should be looking for it all the time. I assure him that these orders are not the end; they are only the start.
– My question is directed to the Minister representing the Minister for Education and Science. 1 ask: Has the Minister’s attention been drawn to a news report of comments by Mr Tom Roper, a university lecturer, who, in referring to the Australian educational scene, said that country people suffer from such serious inequalities that continuing government neglect is criminal? Does the Government acknowledge that there are disadvantages, both physical and financial, to students from country areas who seek higher education in the capital cities? Will the Government, through the Department of Education and Science, investigate such allegations and attempt to provide greater assistance to students who are found to be at such disadvantage?
– I am sure the honourable senator will appreciate that his question is directed to the centre of my interests in education. It is quite obvious that the distance and the expense of getting from the country to the educational institutions for one’s education impose a handicap. It is recognised as a handicap that must be overcome in order to give to the country student population an equitable balance from the point of view of educational opportunity. Decentralisation of educational institutions - and I refer to the university at Armidale, the development of a medical school in an area such as Hobart and the establishment of branch institutions in other country centres, as has been advocated - together with scholarships that take into account the need for boarding away from home and travel allowances, 1 think, are very pertinent. I am obliged to the honourable senator for giving me the opportunity of transmitting his question, as a matter of specific concern, to the Minister for Education and Science.
– I direct a ques tion to the Minister representing the Attorney-General.In view of my serious allegations made during the debate on the motion for the adjournment of the Senate some time ago concerning bomb threats made against Station 2WL Wollongong which resulted in the station withdrawing a radio programme, can the Minister indicate when the Attorney-General’s Department will be able to give me a report on this act of lawlessness?
-I assure the honourable senator that all questions on the notice paper directed to the Attorney-General’s Department have been brought to the notice of the Attorney-General within the last few days and that any outstanding questions are outstanding only because it is necessary for time to be taken to ensure that inquiries elicit complete and accurate answers.I shall give the honourable senator an answer at the very earliest opportunity.
– I ask a question of the Minister for Supply. In view of the fact that the British aircraft industry is one of the best aircraft industries in the world, has the Government ever given consideration to joining with the British industry in the design and construction of such parts of aircraft as we are capable of building? I am not talking about sophisticated electronics. Has any attempt been made to have a joint partnership with the British to build something here?
– During the time that I have been Minister for Supply there have been joint studies, for instance, with the British Aircraft Corporation on one proposal. There is a high degree of interchangeability with the British aircraft industry in matters related to the industry. It is true that we built the Mirage under licence from the French. It is equally true that we built the Macchi under licence from the Italian Macchi company. There have been studies with the British Aircraft Corporation in relation to the needs of the Services. It has to be remembered always that Australia’s requirements are very small in the general sense and, therefore, the sheer economics would not justify the building of an aircraft for the Services where our needs are very small and there is no certainty of the order book for such aircraft being filled. This is one of. our biggest problems. Of course aircraft such as the F111 are so sophisticated that we would not be competent to build them. We must remember that we are a nation of only 12 million people and when we consider maintaining and servicing an aircraft industry we must bear in mind that our local needs are strictly limited. We must, therefore, maintain a high degree of co-operation with other countries. In the past we have done this - notably, to my knowledge, with the British Aircraft Corporation in relation to one particular project.
(Question No. 181)
asked the Minister representing the Minister for the Interior, upon notice:
Since 1 December 1969, when the Minister wrote to me, have any firm departmental or cabinet decisions been made concerning (a) the establishment of a biological centre at Black Mountain, A.C.T., and (b) the declaration of the Mount Kelly region of the Australian Capital Territory as a National Park.
– The Minister for the Interior has provided the following answer to the honourable senator’s question:
(Question No. 218)
asked the Minister representing the Minister for National Development the following question, upon notice:
Will the Commonwealth-State Softwoods Forestry Agreement of 1967, which terminates on 30 June, 1971, be extended for a further period: if so, what is the likely period of the extended agreement.
– The Minister for National Development has provided the following answer to the honourable senator’s question:
At present, under the current agreements authorised by the Softwood Forestry Agreements Act of 1967, the Commonwealth is providing long-term loans, free of interest and of repayment of capital during the first ten years, to cover the additional costs to the States in raising their annual plantings of softwoods from about 28,000 acres in 1965 to about 58,500 acres in 1970-71.
The Australian Forestry Council, which is made up of State and Commonwealth Ministers responsible for forestry, has recommended a second five-year plan for softwood plantings. The question of further assistance, as recommended by Council, is being given consideration.
(Question No. 270)
asked the Minister representing the Minister for Education and Science, upon notice:
– The Minister for Education and Science has provided the following answer to the honourable senator’s question:
(Question No. 261)
asked the Minister representing the Minister for the Army, upon notice:
– The Minister for the Army has provided the following answer to the honourable senator’s question:
(Question No. 332)
asked the Minister representing the Minister for Social Services, upon notice:
What is the total amount of social service payments made to Papuans and New Guineans for the year ending 30 June 1969, in the following categories:
unemployment and sickness benefits; and
– The Minister for Social Services has provided the following answer to the honourable senators question:
– Yesterday Senator Young asked me the following question:
What are the names of the meatworks affected by the United States ban on imports of Australian mutton?
The Minister for Primary Industry has provided the following answer:
We do not disclose the names of firms taken off the United States list of approved exporters. There are two reasons: One, 76 abattoirs are licensed to export mutton but it is not known how many were actually affected by the United States ban although all licences were revoked temporarily from 14th May. More importantly, the Department of Primary Industry does not think it is right to publicise the names of abattoirs. In cases where the difficulty is only minor, it would be quite unfair to ‘brand’ a firm.
– On Thursday 14th May, during a debate on the Estate Duty Assessment Bill Senator Webster asked me whether the amendments could be incorporated in the Department of Primary Industry booklet on tax concessions. The Minister for Primary Industry has provided the following answer:
An edition of this booklet was issued quite recently, and a revised edition would not normally come out for some time. However, it may be necessary for some consideration to be given to revising the booklet earlier than usual, or to finding some other means of making the information available to farmers.
(Question No. 206)
asked the Minister representing the Minister for the Interior, upon notice:
– The Minister for the Interior has provided the following answer to the honourable senator’s question:
(Question No. 207)
asked the Minister representing the Minister for the Interior, upon notice:
– The Minister for the Interior has provided the following answer to the honourable senators question:
(Question No. 208)
asked the Minister representing the Minister for the Interior, upon notice:
– The Minister for the Interior has provided the following answer to the honourable senator’s question:
(Question No. 303)
asked the Minister representing the Minister for Primary Industry, upon notice:
Will wheat farmers who had a short-fall in their quota for the recent harvest be able to add this to their reduced quota for the coming season.
– The Minister for Primary Industry has provided the following answer to the honourable senators question:
The allocation of wheat delivery quotas in any State is entirely a matter for the individual State. Any changes in quotas for the 1970-71 season and any adjustments attributable to shortfalls in deliveries from the 1969-70 harvest will be made under State laws. The relevant provisions of those laws differ from State to State and their interpretation and application are not matters for the Commonwealth.
– Is notice of motion No. 5. General Business, in the name of Senator Milliner formal or not formal?
-I declare it to be formal.
– On behalf of Senator MillinerI move:
Question resolved in the affirmative.
This matter came onto the notice paper by mistake. I think it is agreed that it was a misunderstanding and I ask that it be discharged, the matter having been dealt with.
Senator MURPHY (New South WalesLeader of the Opposition) [2.26 - If I may have leave to add to that, as I understand it this matter relates to a dissent by Senator Cavanagh who is agreeable to the order of the day being discharged. You, Mr President, indicated that this matter was going to be the subject of consideration by the Standing Orders Committee.
Question resolved in the affirmative.
– With Senator Murphy’s permissionI want to withdraw notices of motion Nos 1 and 2. They read:
We originally objected to these regulations and to this ordinance because it was understood that dental hygienists and dental nurses would be acting in the Australian Capital Territory without being under the supervision or control of registered dentists. We understand now that the Minister has given an assurance that he will allow them to practise and exercise their control in the treatment of children’s teeth under the control and guidance of registered dentists. That is the reason why we are withdrawing the two notices of motion. I might just draw to the attention of the Senate how often it happens that regulations are promulgated and then considered and their weaknesses revealed subsequently. It does behove the Ministers in their particular portfolios to give serious, mature and meticulously careful consideration to regulations before they are promulgated so that we do not arrive at this impasse more frequently than we do at present.
– If I may add a little to that, perhaps I should give some explanation to the Senate because these matters have been stood over on a number of occasions. Honourable senators may recall that these notices of motion were about to come on at one sitting of the Senate and just before that there had been certain submissions delivered to all honourable senators and honourable members from, I think, the Advisory Council of the Australian Capital Territory in relation to that matter. I therefore suggested that instead of proceeding on that day these matters be stood over to enable us to consider the submissions. The matters were stood over several times. I had discussions with the Minister for Health (Dr Forbes) and I announced yesterday that I would be moving for a disallowance today, which I intended to do. After that had been mentioned, some time yesterday evening I spoke to Mr Buchanan of the House of Representatives who had a similar motion in the House of Representatives for disallowance. He had had farther discussions with the Minister for Health and with the dentists. Assurances had been given and after the discussions with the Minister and with the dentists it seemed that the assurances would be sufficient to meet the position. Those assurances were of the nature indicated by Senator Dittmer; that is, that the dental therapists must work under the direction and control of registered dentists. That being so, my colleagues and I have considered the matter and we do not see fit to pursue the motion.
Today is the twelfth sitting day of the Senate since 1 gave notice of the motion. The Seat of Government Administration Act provides that a motion must be dealt with within a period of 15 sitting days of giving notice. Therefore by withdrawing the notice of motion we are not prejudicing the position of any other senator who might wish to act in this matter. Any other honourable senator who feels disposed to move a motion on this matter may do so without being prejudiced by the action we are now taking. I have given that explanation because I think the Senate is entitled to know why the matter had to be deferred. I have strong views that such matters should not be deferred but should be pressed on with except where the adjournment of a matter is to facilitate the business of the Senate. We have now considered the matter and at this stage do not desire to proceed with it.
– by leave - I will be very brief. I am glad that the Opposition has decided to withdraw its notice of motion because it is holding up a very worth while project in the Australian Capital Territory. It is a project that has been proved over the last 30 or 40 years to be a success. The agreement reached with the Minister for Health (Dr Forbes) in another place, to which Senator Dittmer referred, does not alter the position ohe iota because it has always been the case that the dental therapists operate under the general surveillance of dentists. There has been no alteration to the practice. The assurance of the Minister confirms what has always been the case and will continue to be so.
Senator MURPHY (New South WalesLeader of the Opposition - by leave - I indicated a few minutes ago to the Senate that by withdrawing this notice of motion the Opposition was not prejudicing the ability of any honourable senator to give notice of motion on the same subject. It has been drawn to my attention that that may not be true. Although the motion must be dealt with within 1 5 days of notice being given, there is a requirement that the notice must be given within 15 days of the tabling of the ordinance. That period of 15 days in this case may well have elapsed. Before the notice of motion is withdrawn it is open to any honourable senator who objects to that withdrawal to do so. In that case the Opposition would not proceed with the withdrawal, thus avoiding prejudice to any other honourable senator. In the absence of any objection now from an honourable senator on the ground of prejudice, I support Senator Dittmer and move for withdrawal.
Question resolved in the affirmative.
Consideration resumed from 19 May (vide page 1579).
– Yesterday I pointed out that 1 had not received a certain letter from the Minister for Civil Aviation (Senator Cotton). I now have that letter in my hand. It contains the typical waffling that comes from any government department. As I said yesterday, I am sorry that the Minister did not see fit to make sure of the accuracy of the statements it contains. One complaint I made was that airlines do not inform passengers when there is delay or cancellation of flights. The Minister states in his letter that he is assured by the airlines - and I am sure that they would so assure him - that when delays do occur the airlines do their best to inform passengers of those delays. But this is not true. Members of Parliament get special VIP treatment, but when they are away from their home State they are rarely telephoned by the airlines to be told that a flight on which they are booked is to be delayed. In fact, one senator was at a committee meeting in this building and, so that he could leave at the last possible moment, he rang the airline and asked: ‘Is there any delay?’. He was told: ‘No’. When he got to the airport he found that there was at least half an hour’s delay. The airline must have known about that before he rang up.
But that was not the point about which I was complaining to the Minister. I was complaining about people actually being at the airport terminal waiting for an aircraft and being informed at the scheduled time of its departure that there will be an hour’s delay, that there will be a 2-hour delay or even that the flight has been cancelled. This happens on innumerable occasions. As Senator Little remarked to me, why cannot the airlines co-operate in this matter? After all, this happens with both airlines. When one of the airlines realises that an aircraft will be delayed - sometimes they know that an aircraft has not even left Melbourne when it is due to leave Sydney; so they know that there will be a delay of at least li hours - why cannot it make arrangements with the other airline? After all, it is a knock for knock sort of policy. What one airline makes up on the swings it also makes up on the roundabouts, I expect.
So, all we are asking is that the Department of Civil Aviation put some pressure on the airlines. The only other answer is to have a third airline to make sure that they work properly. There is no doubt that something can be done about the position. If one of the airlines is aware that an aircraft is late, it should make arrangements to transfer passengers to the other airline. On many occasions aircraft are only half full. Therefore there is. no reason why the airlines should not do that. Surely the convenience of passengers should be considered.
The other point about which I complained was that aircraft travel at the same time. From the number of ‘hear, hears’ that I heard from honourable senators on both sides of the chamber, it is obvious, as we represent the members of the public, that they are not satisfied with aircraft leaving at the same time. The Minister said in his letter - I presume that it was written by the Department:
The paralleling of departure’ and arrival limes of the airlines, where it exists, has been criticised on a number of occasions. There are clear cut travelling patterns in Australia and both airlines endeavour to satisfy demonstrated public demand. I should expect it to move its schedules so as to exploit what it believed to be the advantageous position.
That is not quite true either. If the airlines wanted the correct times, why did Ansett Airlines change its times and why did Trans-Australia Airlines change its times the following day to catch up with those of Ansett Airlines? Of course, that meant that the aircraft of both airlines again left at the same times. So the statement in this letter is not quite accurate.
I mentioned most of these matters yesterday. I am just filling them out now. I support Senator Little’s suggestion that it should be compulsory for an airline to notify passengers of delays and to make arrangements for them to travel by the other airline, wherever that is possible and wherever the time factor will allow that.
– That will not work if the times of departure are changed, will it?
– Yes, it will, because if the times of departure are changed a passenger will not have to wait for the airline to transfer him; he will be able to do it himself because he will know that the other aircraft will be leaving half an hour or an hour later. So he will not have to worry.
The final matter - I raise this again - is the difference between a charter operator and an airline. If companies are given a licence they have to operate according to schedule. But they do not operate according to schedule. It is no good saying that they have to cancel a flight because of maintenance requirements and so on, because a person can ring a fortnight ahead and be told: ‘We have cancelled that flight on that day’; but the flight will run to schedule at other times. This is contravening the regulations under which they are given a permit. The Department has every right to clamp down on them, but it does not do so. I raise these matters because we are getting pretty fed up with the 2-airline policy as a result of the overutilisation of aircraft. There are no spare aircraft. This results in the airlines using their aircraft to the utmost. I do not blame them for doing that, because they are expensive aircraft.. But at least the airlines should think of the passengers occasionally and try to help us instead of helping themselves all the time.
– I want to raise a point of procedure and really a point of order. I deliberately did not do it while Senator Turnbull was speaking because the matter that he raised today was the subject of debate during the Committee stage yesterday. I did not think it would be appropriate to cut him off while the Chair had allowed a high, wide and handsome debate yesterday. But I invite you, Mr Chairman, to give some ruling as to whether it is appropriate, when we are dealing with the Committee stage of these appropriation Bills, to allow a debate which can range all over the spectrum and refer to any aspect of a political problem. If we do that, of course, we defeat the purpose of debate on the appropriation Bills. I suggest that other forms of the Senate are available to honourable senators to raise such matters. You, Sir, have to make the decision, but I suggest to you that the appropriations we are discussing are short term provisions which take us to the end of the financial year. They are supplementary to the provisions with which we dealt in the last Budget session. We also have supply Bills which predicate five-twelfths of the money we need for the financial commitments of the nation for the first fivetwelfths of the next financial year. I ask you, Mr Chairman, to rule that we should confine our debate in the Committee stage to the line items set out in the Appropriation Bill. In fact, until this year, or until certainly last year, when we were dealing with supplementary appropriations and estimates it was traditional that we passed them more or less on the voices. I am not suggesting that that should be done, but I do suggest that if we are to have a debate which ranges over 26 different departments and deals with any subject, then it will mean a very long winter.
– I realise the difficulty here, Senator Anderson, but I am advised that it has been the practice when dealing with appropriation Bills to allow discussion on administrative matters. However, I ask honourable senators to confine their remarks to the estimates and to keep fairly close to the Appropriation Bill before us.
– I want to direct my remarks to the Prime Minister’s Department. I do so because of an answer which Senator Anderson gave to a question I asked recently. Of course, under the Standing Orders I could not reply to his answer to me. But because of the urgency of the matter, I am adopting this round about way of dealing with it. I want to refer to the responsibility of the Commonwealth Government for the grant that it gave to the Sydney City Council for the construction of the Chifley Square memorial fountain. Senator Anderson probably misunderstood me. He took the point that because the Commonwealth gave only 20% of the cost of the fountain, it was not the thing to ask the Sydney City Council why nothing has happened with the fountain project for the last 3 or 4 months. This is where 1 part company with him. I speak to him not as the Leader of the Government in the Senate but as a man who was also a mayor of a prominent municipality in New South Wales. 1 think he will agree with mc that even though the Commonwealth has contributed only one-fifth of the capital invested in the Chifley Square memorial fountain, we are entitled to know why nothing has happened with this project in the last 3 or 4 months. 1 speak with a bit of feeling on this matter because Senator Anderson knows that, like many other New South Wales senators. I park my car behind the Commonwealth Centre and people say to me: is this another white elephant?’ The present Mayor of the City of Sydney came into office beating a big drum and saying that it was a business aldermen’s set-up and that he was going to make Sydney move. If he cannot get this fountain completed within a certain time, as we have contributed 20% of the cost of the fountain we are entitled to know whether the contractor has welshed on his obligation and whether, when we get the estimates for the Prime Minister’s Department later this year, we will see the hand come out again and request another $20,000 for the fountain. It is as simple as that. I am not indicting the Commonwealth Government for what went wrong, but 1 do say that as we contributed 20% of the cost of the fountain we want to know why there is so much inactivity there. It was simply to get round the requirements of the Standing Orders that I took this opportunity to ventilate this matter.
– I should like to raise a matter with the Minister for Civil Aviation (Senator Cotton). It follows on a matter that was raised yesterday by Senator Cavanagh relating to the practice of requesting that air transport be provided by aircraft of the Department of Civil Aviation instead of by the Royal Australian Air Force VIP Flight, as is the normal custom. The Minister, in reply to Senator Cavanagh, said that there had been several requests lately in special cases in which the Department of Civil Aviation had supplied air transport. Is the Department of Civil Aviation building up a flight of transport aircraft which would be supplementary to the RAAF VIP Flight? Is the number of requests being made for this special type of transport greater than can bc covered by the RAAF VIP Flight? Has the Minister any idea of the difference in cost involved in transporting passengers on flights by Department of Civil Aviation aircraft and on flights by VIP aircraft?
Pilots employed by the Department receive a considerably higher salary range than do RAAF pilots. That could have a significant influence on the loss rale through resignation of RAAF pilots going to airlines. I have no doubt that the higher salary range in the Department of Civil Aviation would encourage pilots to leave the RAAF if the Department built up the practice of providing special transport to supplement the VIP Flight. Does this follow from the replies the Minister gave yesterday? ls this just a temporary expedient to provide transport on request or will the Department of Civil Aviation set up a separate section to provide VIP transport?
– Senator Mulvihill referred to a question he asked and an answer I gave him some time ago in relation to the fountain in Chifley Square. I supplied some information on the Commonwealth’s contribution. I now take on board the point he is really making which is that he wants to know the reason for the delay and why the Council of the City of Sydney is not going on with the project. I would need to make some inquiries through the Prime Minister’s Department. I accept the honourable senator’s request and will obtain some information for him.
As to the point made by Senator O’Byrne, I have been informed by the Minister for Civil Aviation (Senator Cotton) that there is currently an examination of the involvement of the Department of Civil Aviation in flights and whether there could be an arrangement whereby in certain regards there could be a cognate situation with Royal Australian Air Force VIP flights. The
Department of Civil Aviation, the Department of Air, the Treasury and the Prime Minister’s Department are involved. The points the honourable senator made are topical. The aspect be raised as to salary range could well have an effect upon the loss rate. I take that on board. I have no doubt that would be one of the considerations in this matter. As I have said, the position is being examined bin no decisions have been taken to date.
Bill agreed to.
Bill reported without requests; report adopted.
Bill (on motion by Senator Anderson) read a third time.
Consideration resumed from 12 May (vide page 1304), on motion by Senator Anderson:
Thai (he Bill be now read a second lime.
Question resolved in the affirmative.
Bill read a second time, and passed through its remaining stages without amendment or debate.
Consideration resumed from 14 May (vide page 1477).
Bill agreed to.
Bill reported without requests; report adopted.
Bill (on motion by Senator Anderson) read a third time.
Consideration resumed from 14 May (vide page 1478).
– -I wish to ask a question in relation to the additional appropriation for the Department of Shipping and Transport. I refer to Division 891 - Payments to or for the States. 1 refer in particular to the expenditure under the Railway Standardisation (South Australia) Agreement Act. The construction of a link between Adelaide and the east-west standard gauge system is being held up at present because of the Government’s decision to have private consultants investigate the proposal to link South Australia with the standard gauge system, which successive South Australian governments have said should be accepted as a Commonwealth commitment regardless of consultants’ advice.
Following upon the representations of 2 governments the Commonwealth agreed to have the matter investigated by private consultants. We have been told that the report of the consultants is available, but no decision has been made. I would like to know whether, firstly, the responsible Minister can inform me what expenditure has been incurred on obtaining the opinion of the private consultants concerning this work. ls it a fact that the South Australian Hailways Commissioner and the Commonwealth Railways Commissioner proposed certain standardisation work which could have formed the basis of a link with Adelaide? When will the report be made to Ministers, and members of Parliament for them to consider? Does the report plan the conversion of the northern part of the South Australian system, as was agreed upon in 1949?
– My brief docs not extend to the depth of material required to answer the questions asked by Senator Bishop. As I have done in the past, 1 will take note of the points made and refer them to the Department of Shipping and Transport for a considered reply. The only explanation which 1 have available to me - it does not add very much - is that provision is made under this vote for financial assistance to the State of South Australia within the terms of the Act. Having regard to the contractual commitments and works in progress, it will be necessary to provide $600,000 to meet calls from the State during the supply period for reimbursement of expenditure Incurred. The point about that, as the honourable senator will appreciate, is that this is an advance for five-twelfths of the year. This matter will appear in a much more significant way in the Budget Session. So that the honourable senator may have information for subsequent discussion during the Budget session, I will attempt to get answers to the points that he raised.
– I speak to Division 920 - Advance to the Treasurer. The provision there is to enable the Treasurer:
The amount there is $20m. A pretty sizable amount will be made available to the Government, if this legislation is passed, for some unspecified purposes. The Government is saying to Parliament that for unspecified purposes it needs a substantial amount because it does not have that much in’ its coffers. There is a way out of this situation: We have moneys which ought to be available to us. I refer to the very substantial sums in the United States of America which have been paid by us in connection with the Fill aircraft. In the past the Senate has passed several motions condemning the Government for its mishandling of the purchase of these aircraft. I think there is little likelihood of the Senate changing its mind on that matter. I think that the country as a whole is quite convinced that the Government has mishandled the affair.
Having reached that stage I think that, as a nation and as a parliament, we ought to be looking to the future. I would like to see the Government cease trying to defend itself by saying that it has handled the matter properly - an argument which will never convince us - and stop having one hand tied behind its back. I would like to see the Government demand a fair go from the United States and a return of the moneys which have been paid. We have neither the goods nor the money. The arrangements which we have entered into have failed totally both from the strategic aspect and from the point of view of getting the aircraft which we ordered. The Government is in a position in which, in negotiating with the United States, it is unable, I would think, to come out as forcefullt as it ought and say that the matter has been bungled from beginning to end and that the United States has made a hash of it. The Government is concerned that it will be criticised further in Australia. I do not think we can say any more forcefully than we have said how much our Government has failed to protect us.
I would like the Government to recognise that it has made a mistake. It is not infallible. It ought to accept the judgment of this Senate and the judgment which has, in my view, been passed by the people of Australia. The Government ought to tell the United States of America the kinds of things which have been said here. The Government ought to be passing back to the right quarters the matters for which it has been criticised. It ought to stand firm and say: Look, we are not going to be treated like this. We are not going to be dealt with in such a way that we will not get the goods we ordered, in the context in which the order was given, and at the same time will be deprived of a considerable amount of our money.’ Mention has been made of our losing over $100m and there is some talk of the figure being $150m. This is a tremendous amount of money in any man’s terms. Australia has not had a fair deal. I would like the Government to approach this matter on the basis that it will bow to the expressions which we have heard in the Senate and concede that it has made an error. If it is at all possible-
– What do you say was the error? Was it the original purchase?
– The error has been in the original purchase and in the handling of the matter all the way through. I would like the Government to acknowledge this. I would like the Parliament, in some joint way, to put this nation in the strongest position so that it will get the best possible result out of this unhappy incident. I do not think the Government is doing this at the moment. I think for at least half the time the Government is concerned with protecting itself and insisting that it never made any mistake, that the Fill transaction has been a wonderful deal all the way through. This approach does not put the Government in a strong position to negotiate on behalf of the nation, t think it ought to be prepared to draw a line somewhere and say that errors have been made and Australia has received a rotten deal out of this contract. The Government should insist that Australia get the best out of this wreckage and that it will not be treated in such a way that it will get neither the aircraft nor its money back. It seems to me that from any reasonable approach Australia should bc getting its money back entirely if it does not get these aircraft. That seems to me to be the practical position. The relevance to this is-
The CHAIRMAN (Senator Bull)Order! Senator Murphy, f draw your attention to the fact that this Bill does not deal with defence.
– The Bill deals with an advance to the Treasurer for unspecified matters to make money available for expenditure pending the issue of a warrant to the Governor-General specifically applicable to the expenditure. That means that the money can be spent on anything. It can be spent on defence, on paying more money for the FI 1 1 aircraft, or paying money for an investigation to get Australia out of this deal, lt could be to pay for negotiators to go to America and get Australia out of this deal. I suggest to the Government that, in the national interest, it ought nol to start negotiating wilh the United States from a position of weakness, lt is desperately trying to defend what the rest of us think is indefensible. The Government should accept that a mess has been made in the past or. if you like, some errors have been made, or that not sufficient steps were taken to protect Australia. Let us move from that position and insist that Australia get a fair deal in the national interest.
– As a matter of fact, the item to which Senator Murphy refers was dealt with in the Bill which we passed a few moments ago. I felt that he was raising a broad principle in relation to this Advance to the Treasurer of S20m and I feel bound to point out to him that this has been the practice for the last 24 years and, in fact, I understand that the amount has remained the same. I recognise that he was using this as a vehicle. We could have, for instance, a national disaster in which it would be necessary to give some assistance to the States.
– I am not opposing that as a principle.
– I realise that and I recognise that the honourable senator used it as a vehicle to make a point about the Fill. The Fill is the subject of a statement listed on the notice paper. 1 would suggest that if and when we come to that matter for debate Senator Murphy should make again the points that he has made.
– 1 refer to Division 810, which provides for $5,200,000 to be spent by the Department of Civil Aviation on capital works and services. The Minister for Supply (Senator Anderson) may say that I am relating something to the programme which is not strictly relevant but I raise the question of the amount which we intend to spend as an incidental part of the programme for civil aviation communications and other aids in relation to our programme of ordering aircraft from overseas. I have raised with the Minister the matter of offset and coproduction orders. In March the Minister for Civil Aviation (Senator Cotton) announced that he agreed with the orders upon overseas suppliers of $80m worth of aircraft - a total of 14 aircraft - to meet the requirements of Trans-Australia Airlines and Ansett Airlines of Australia for several years. Although I appreciate what the Minister said in relation to a number of my questions about the now recognised efforts to get work from overseas, up to the present time we have orders from all of these people for only $500,000 worth of sub-contracts. I wonder whether in these circumstances any real positional policy by the Government ought to be related to the amount of orders which we place with overseas suppliers of aircraft. While the Minister has mentioned that we are making a modest stand in this regard is there any chance of relating whatever we might get back to the orders we place overseas?
– The short answer to the point made by the honourable senator, of which I have taken note, is that this line of the est:mates is in respect of the generality of the Service requirements on a 5/12ths basis. I cannot add very much lo what I said at question time beyond reiterating the point that this is very carefully watched by me as Minister for Supply, by my Department and by the Minister for Defence (Mr Malcolm Fraser) and the defence complex. We look and will be looking all the time for an opportunity for Australia to get some feedback when we place overseas orders. The honourable senator has to appreciate that in some fields we do not yet have the capacity and the technical know-how, not because we do not have it inherently but because of the order book and the type of order that we would need to receive. In these circumstances it is just sheer commonsense to purchase overseas. In other words, we would not spend $5m or $6m tooling up and gearing up to produce a piece of equipment which, when we got the order, would be worth, perhaps, only $250,000 because that would be our requirement over a period of years. This is a very difficult field and judgments have to be made. I can only give the honourable senator and the Committee the assurance that we are looking and at all times in the future will be looking for these orders. The possibility of Australia getting some sort of order if we let a contract overseas is posed every time a piece of paper comes across my desk which relates to a newly placed order. We also question whether we can provide certain parts of the order in existing establishments or by setting up some new establishment. I am sure we are all as one on this issue. It is just a question of how hard we oan push it.
– I should like to get some information, if it is available, about Australian Capital Territory services under the Department of the Interior for which $ 1 60,000 is to be appropriated. Will the amount proposed to be expended under this Bill bring to some conclusion the plans for extending the water supply to provide for Canberra’s future? The water supply for Canberra is a problem which has developed down through the years. It has been a problem to have plans far enough in advance to make certain that the reservoirs supplying one of the most rapidly growing cities in the Commonwealth is assured of a future supply of water. I should like to know whether this proposed expenditure will be devoted to rinding additional sources of supply outside the Australian Capital Territory, whether other supplies are being developed and whether or not any finality has been reached with regard to long range plans for the future supply of water.
– I cannot give the honourable senator any. answers about Canberra’s water supply, but I can tell him what the §160,000 represents. I am sure that it would gladden the hearts of all who believe in the tourist attractions of Canberra and the Australian Capital Territory to know that this new item of expenditure which appears in this Bill is for the purpose of expenditure on the Black Mountain Tourist Park. I presume that it will be to provide for embellishments to that park as a tourist attraction. As to the question about the water supply, when I go through Hansard after the Committee debate and pick up all the loose ends I shall see that a query is sent to the Department of the Interior as to what the situation is in relation to the water supply.
Bill agreed to.
Bill reported without amendment; report adopted.
Bill (on motion by Senator Anderson) read a third time.
Debate resumed from 19 May (vide page 1566), on motion by Senator Dame Annabelle Rankin:
That the Bill be now read a second time.
– On behalf of the Opposition I move the following amendment to the motion by the Minister for Housing (Senator Dame Annabelle Rankin), who represents the Minister for Health (Dr Forbes) in this place, that the Bill be now read a second time:
That the following words be added: ‘but the Senate is of the opinion that, while the Bill represents some improvement, a National Health Insurance Commission financed from graduated contributions would pay for medical and hospital services for all more equitably and economically’.
The purpose of this amendment is to enable us to highlight the present Government’s failure to introduce a health scheme which will overcome all the anomalies of the existing scheme and to provide an alternative which will ensure to every Australian citizen the best treatment available to him in this country within the financial ability of everyone. The Government’s dillydallying and the wrangling that has been engaged in in public debate over Australia’s national health scheme arc a scandal comparable to the Government’s infamous, inefficient and incompetent handling of negotiations to purchase Fill aircraft. In all the considerations of the legislation now before the Senate it appears that the interests of patients - of the Australian community which is primarily involved - have been pur last.
On 14th May it was reported in the Sydney ‘Daily Telegraph’ that Dr Forbes, the Minister for Health, had told a meeting of the Government Parties that the Government could not get any agreement with the medical profession as a whole and that it should now - I emphasise the word ‘now’ - consider the position of patients and the public. Although we of the Opposition intend to move a considerable number of amendments at the Committee stage of the debate, we do not oppose the Bill. We take that course only because the Bill represents an improvement of the existing costly, wasteful and anomalous national health scheme. The scheme discriminates between the healthy and unhealthy. It eases from the shoulders of wealthy people their share of responsibility for the health of the Australian community and a heavier burden is consequently placed on the shoulders of the poor people or men supporting large families.
I ask rhetorically: How can any scheme such as the present one be considered just and equitable when a wealthy man can afford to stay out of it and, in other words, take the risk of being sick? If he or any member of his family does become sick he can write off a substantial part of his medical and hospital expenses as income tax deductions, whereas a man receiving only an amount, equal to the average weekly earnings must pay in contributions the same amount as a man who earns twice or three times as much and who may have only as many or even fewer family responsibilities. The Australian people have the Opposition in the Senate to thank for bringing out into the open arena of public debate the grave shortcomings of the existing national health scheme. In March 1967 - about 3 years ago - the Opposition in the Senate gave notice of a motion to appoint a Senate select committee to inquire into health and hospital costs in Australia. Until that time it had been the cry of supporters of the present Government - and it continued for a short time thereafter - that the Australian system of voluntary health insurance was the best system in the world. They claimed that other countries looked on us with envy, that the health insurance funds were administering the scheme efficiently, austerely and without extravagance, and in the interests of contributors. It was said that the Australian people were really getting value for their money.
The policy of the Government at that time was one of laissez-faire - leave well alone - as was instanced in an answer given to me by the Minister for Health about 2 years ago when I asked about the purchase of a private aircraft, at a cost of about $40,000, by a large health insurance fund operating in New South Wales. The plane was purchased at that time for the use of the executive of the fund. While the Government adopted that attitude, costs were increasing for the ordinary men and women in the street. Contributions to funds by members were on the increase and they are to be further increased following the passage of this legislation. Refunds from the funds were diminishing in terms of money value and the amount of Commonwealth benefit was static as were, by coincidence, child endowment payments awarded by this Government.
The gap between fees charged by medical practitioners and the refunds paid to contributors had widened to such an extent that for many Australian citizens it meant the difference between obtaining treatment from a doctor and effecting a home cure. Reserves held by the funds had reached astronomical amounts, while the States were crying out for funds to construct sufficient hospitals for the needs of the people. Even after the Opposition gave notice of its motion in the Senate in March 1967, Government supporters and the funds continued to maintain that the present scheme was the best in the world. The Voluntary Health Insurance Council of Australia continued its expensive publicity drive lauding its own work and castigating those people who dared to criticise it. Some time ago the Blue Cross Association went on record as saying:
The aim must be to have a constant stream of stories reaching the public and all containing some aspect of our story quietly and unobtrusively, presented in a way so calculated to build that confidence in and high regard for the present health scheme that any attempt to nationalise it no longer has any significant support from the public and therefore ceases to be attractive as a political tool.
In short, the funds not only were the recipients of public moneys for health insurance purposes but . also became spenders of those moneys on political propaganda for their own self-preservation. The complacent attitude of the Government to national health continued, even after March 1967 when the Opposition gave notice of a motion in the Senate for. the appointment of a Senate select committee. During the debate on that motion supporter after supporter of the Government was reported in Hansard to have claimed that the Australian health scheme as it was then was the best in the world.
An event of historical importance occurred in this chamber on 3rd April 1 968, about 13 months after the Opposition gave notice of its motion for the appointment of a Senate select committee. On that day the Senate agreed to the appointment of a Senate select committee to inquire into health and hospital costs in Australia. On 4th April 1968 Senator Dame Ivy Wedgwood and Senator Sim of the Liberal Party, Senator Bull of the Australian Country Party, Senator Dittmer and myself of the Labor movement and Senator Turnbull were appointed to the Committee. I venture the suggestion now that had the Senate voted otherwise, the hopeless, wasteful and extravagant health scheme that Australians had then and still have would be allowed to go on its merry way today. Had the Senate not established that Select Committee I very much doubt that the Government would have appointed the departmental committee commonly referred to as the Nimmo Committee. Within 14 days of the Senate’s agreement to the establishment of the Select Committee the Government acted to appoint a Commonwealth committee of inquiry. The Minister, in announcing the establishment of the departmental committee - the Nimmo Committee - stated that the Government’s purpose in setting it up was to secure an independent and impartial review of the system after 16 years of operation. The Nimmo Committee heard evidence from a large cross-section of the Australian community. Indeed, it visited Canada to investigate that country’s health scheme.
Being an independent and impartial committee - to use the Minister’s term - it made 42 specific recommendations affecting not only the Commonwealth Government but also the State governments, the medical profession and the health insurance funds. Let me quote some of the findings of that Committee - an independent and impartial committee, to use the Minister’s own words - which was established by the Government. It found:
Madam Acting Deputy President, you will recall that in evidence given before the Senate Select Committee a deputy directorgeneral of the Department of Health said that he saw nothing in the Nimmo Committee’s report which in the light of what the Department knew was exaggerated. The Government then learnt from its own independent and impartial committee that what the Opposition had been saying in this chamber and in another place for a number of years was right. The findings of the Nimmo Committee were the greatest indictment possible of any voluntary health insurance scheme that was being administered by the health funds under the control of the Commonwealth Department of Health. In our opinion, they proved that it was a scheme that was worn out and that it was a system that was top heavy with dead wood. We said then, as we say now. thai the time has come to change the system completely rather than to try to make the present hotchpotch work.
I suggest that within 2 years, despite the improvements that will be made to the present health scheme by the passage of this legislation, another crisis will arise in relation to the bridging of the gap between the amount of the doctor’s fee and the amount of the refund and in relation to the amount of contributions by workers to the funds. Indeed, I suggest that the Bill now before the Senate will play a prominent part at any forthcoming election in the defeat of the present Government. If the Government is adamant on preserving a system of voluntary health insurance under which some citizens are covered and others are not, then one complete government scheme, in my opinion, would be far better than the present unsatisfactory arrangements under which there are 78 registered medical benefits organisations and 109 registered hospital benefits organisations. Because s«me funds operate both medical and hospital funds, in Australia today for all practical purposes there are 117 different funds.
The Senate Select Committee also sat and took a great deal of evidence during the time the Nimmo Committee was sitting and taking evidence, lt was chaired by Senator Dame Ivy Wedgwood. As an Opposition member of that Committee, I pay her and my fellow members of that Committee a compliment for having done a very effective job on behalf of the Senate and on behalf of the Australian people. That Committee already has presented an interim report to this Parliament. That was presented in September 1969, about a month before the last Federal election. The Committee is in the throes of bringing down its complete and detailed report. But in its interim report - I mention this to support the findings of the Nimmo Committee - the Senate Select Committee had this to say, amongst a great number of other things:
The Committee closely considered all the suggestions placed before it and finally decided, by a majority vote, that ite Report should be framed with the intention of recommending ways of extending and improving the existing voluntary health insurance scheme, and of providing the maximum levels of health care generally throughout the Australian community. Two members of the Committee, Senators Dittmer and McClelland, dissented from this basis, and their dissent is attached to this Report. The Committee records the fact, however, that the two dissenting members, having recorded their basic dissent, then joined the other members of the Committee in the task of framing recommendations which, while falling short of their own desired objectives, would effect improvement of the present scheme.
Therefore we have a situation in which the Nimmo Committee - the independent and impartial committee established by the Government - said that the existing scheme was unnecessarily complex and beyond the comprehension of many and beyond the financial capacity of many, and the Senate Select Committee said that an improvement of the existing scheme bad to be effected. The Government proposals contained in this Bill seem to stem from the 42 recommendations of the Nimmo Committee. But I suggest that if the Government had waited for the Senate Select Committee’s full report it would have found that there is still much to be done if voluntary health insurance is to cater adequately for the health needs of the Australian community.
One recommendation, which was made by the Nimmo Committee and which the Minister himself said on 4th March he would implement, was for the establishment of a national health insurance commission. This matter was referred to by the Nimmo Committee in its report of March 1 969, when it had this to say:
If the deficiencies in the scheme gre to be eliminated it is the view of the Committee that a new approach to their responsibilities is required by all the interested parties. Their responsibilities need to be defined and discharged in a spirit of co-operation with particular attention to the interests of contributors. The Committee considers that this objective would be advanced by the transfer of the administration of the health insurance scheme from the Commonwealth Department nf Health to a National Health Insurance Commission with as much independence as possible. The centering of administrative responsibility and policy advising id a Commonwealth Department has not been conducive to the development of a spirit of co-operation and sharing of responsibility by the other parlies, who have felt little duty to help what they refer to as the Commonwealth scheme”. Whilst the transfer of these functions to the Commission would not wholly remove the difficulties inherent in securing a co-operative approach, it would significantly reduce them.
Then the Committee went on to recommend that a number of people be appointed to such a commission - one being a person qualified to represent the interests of contributors and patients. In response to that recommendation brought down by the Nimmo Committee to the Government in
March 1969 - namely, that the Government establish a national health insurance commission - the Minister for Health made a statement to the Parliament on 4th March. He said:
The administration of health insurance received considerable attention by the Nimmo Committee and its recommendations on this subject have been thoroughly reviewed by the Government. It has been decided to adopt the Committee’s proposal that a National Health Insurance Commission be established. The Government is currently giving consideration to the composition and functions of the new Commission.
The Nimmo Committee made such a report in March 1969, and in March 1970 the Minister for Health said that he would implement the recommendations of the Nimmo Committee. It is now May 1970. The National Health Bill is before this Parliament, and there is not one word in the Bill about the Government deciding to establish such a commission. The Government received the Nimmo Committee’s report 15 months ago, and whilst major amendments to the national health scheme are now being made under this Bill, there is nothing included amongst the amendamendments about the establishment of a commission which would have within its membership, as I have said, a person representing the interests of contributors and patients.
There is one other matter to which I should refer, and that is the provision introduced last year to subsidise the payment of health insurance premiums of low income earners. I should have thought that if the Government had the supreme faith in the voluntary health insurance funds that it professes to have, once it accepted a person as being eligible for subsidy under the provisions relating to low income earners, the Commonwealth ultimately would pay the subscriptions of that low income earner to the fund of his choice. But I am given to understand that this is not the situation. I understand that in such cases the fund pays the person his fund and Commonwealth benefit and then the Commonwealth refunds to the fund the amount that was paid out by the fund to the low income earner. In other words, the contribution of the underprivileged person is not being paid by the Commonwealth to the fund. The Commonwealth, in fact, is carrying the burden of insurance of these low income people, very much in conformity with the policy enunciated by the Labor movement at the last federal election, namely, the policy of universal coverage. If this is so, then I suggest that the present Government is only making a mockery of the continuation of the present costly voluntary health insurance scheme.
I suggest that the Government tolerates the continuation of the voluntary health insurance scheme because the system has grown into such a Frankenstein monster. The funds themselves have vast amounts of money at their disposal. They spend large amounts of money on public relations campaigns and on expensive and wasteful advertising campaigns. They hold astronomical sums in reserves. As at 30th June 1967, medical benefits funds held some $23m in reserves and hospital funds held about S56m in reserves all told, in the round, some $80m of contributors’ funds. I have read elsewhere that since that time 3 years ago, the reserves have risen to about $90m. Expenditure on health services in Australia in 1966-67 - the last figures available to us - amounted to $1,1 18m, principally provided by the Commonwealth, the States, local government, voluntary insurance and patients’ fees. Indeed, the amount of $1,1 18m is broken down in this manner: The Commonwealth provided $3 27m - and I will leave out the decimal points - for expenditure on health services in 1966-67; the States provided $240m; local government provided $l1m, making a total of $579m. Voluntary insurance provided $145m, patients’ fees provided $382m, and expenditure under the broad category of ‘others’ accounted for $ 10.47m. Expressed as percentages of the expenditure of SI, 118m on health services in Australia 3 years ago, the Commonwealth provided 29.3%, the States provided 21.5%, local government provided 1%, patients’ fees provided 34.2%, voluntary insurance provided only 13% and the ‘other’ category accounted for 0.9%, making a total of 100% of the $1,1 18m. We believe that these percentages highlight the case of the Labor movement regarding the inadequacy of voluntary health insurance in Australia.
Sir Ronald Grieve, a director of the Medical Benefits Fund of Australia - if not the largest fund, certainly one of the largest funds in Australia - said in evidence before the Senate Select Committee that he objected to compulsory insurance in every shape and form and that if there were no voluntary insurance schemes he would prefer, in fact, that there be no compulsory or universal scheme.
– Who said that?
- Sir Ronald Grieve, a director of the Medical Benefits Fund of Australia. In other words, if he cannot have his own way, if the Government is not going to have voluntary health insurance and dares to bring in a universal health insurance scheme, there will be no co-operation from such people as Sir Ronald Grieve and that so far as they are concerned the Australian community can be thrown to the wolves. We say that the time is ripe for this Government to look at the proposal of universality which was so adequately put forward by the Labor movement at the last federal election.
In 1938, some 32 years ago, Mr Casey, as he then was, the Federal Treasurer, introduced the National Health and Pensions Insurance Bill into the Federal Parliament. At page 795 of Hansard of 4th May 1938 he had this to say on the subject of voluntary insurance:
Voluntary insurance is to be highly commended as indicative of individual thrift and foresight . . voluntary insurance has failed to cater for a substantial part of our population. The greater portion of those who stand in most need of insurance are underinsured They are either unable to afford it without the assistance of the Government, or lack the initiative to become and to remain insured. The story of voluntary insurance is marred by the tragedy of the number of lapses from insurance due to sickness, unemployment and other misfortunes.
The advantages of Labor’s scheme of universal coverage over voluntary health insurance are concise and clearcut. Under our scheme every member of the Australian community would be assured of comprehensive medical and hospital care. Under our scheme nobody would be required to pay more for health insurance than that which he could afford to pay. The right to choose where and from whom to receive medical care is preserved for all sections of the Australian community. We say that Australians arc entitled to a health scheme which will provide proper service at a cost that all sections of the Australian community can afford to pay. The Australian people need a scheme which meets the requirements of the entire community regardless of age and income.
The Government said in October last during the general election campaign that its proposals in relation to national health would cost some S16m. Now, without including the establishment of a national health commission the proposals are estimated to cost about $30m. The scheme which the Government now is trying to expand has brought with it considerable lobbying from those who have a vital interest in it, but as the ‘Canberra Times’ said in its editorial on 6th March last:
The general intent of the Government’s plan is to reduce the cost of illness to the public, but this would be done entirely at the expense of the taxpayer and the contributor.
Because this Bill will remove some of the anomalies of the present costly and wasteful scheme we do not oppose it. However in the Committee stage we intend to move amendments which we suggest will improve the legislation still further. We say also that when a Labor government is elected the Australian people will receive a truly national health scheme which will provide economically and equitably hospital services for all, and that the scheme will be financed by graduated contributions. Again the Labor movement will lead the world in the field of national health in the spirit of true social reform.
The DEPUTY PRESIDENT (Senator Lawrie) - Is the amendment seconded?
– Yes. I second the amendment.
– I rise to support the Bill before the Senate and, naturally, to oppose the amendment proposed by Senator McClelland. The honourable senator used some rather extravagant language in condemning the health scheme. I noted a couple of the words he used. He referred to the ‘wrangle’ which has been taking place between the Government and some sections of the medical profession, and he also used the word ‘scandal’. Well, he is entitled to use those words because, after all, he is putting forward a different philosophy from that from which we on this side are prepared to accept. As a member of the Senate Select Committee on Medical and Hospital Costs I sat with my friend Senator McClelland for many days and hours over a period of several months and I think we understand and respect one another’s opinions although we differ on the philosophical approach.
It is very easy for Senator McClelland to proclaim the great benefits of the scheme propounded by the Australian Labor Party. But it has never been put to a test. Indeed one would suggest that the discussions which have taken place between the Minister for Health (Dr Forbes) and the doctors - probably at times heated - would have been even more heated if the Labor Party’s scheme had been implemented because whatever scheme there is. whether it is the present voluntary scheme or a compulsory scheme as proposed by the Labor Party, some agreement has to be reached between the Government and the medical practitioners unless there is to be a nationalisation of medicine as in the United Kingdom. I do not think that it is useful to make comparisons with what has happened in the United Kingdom and what would happen under the scheme proposed by the Australian Labor Party because there are essential differences. Although we cannot draw too many conclusions from the British scheme I believe that there are lessons to be learned from it. Some of the lessons are that it becomes tremendously extravagant and that people who receive something for nothing abuse the services which are provided.
– You get nothing for nothing and very little for 6d.
-I think that is a very sound philosophy. One can talk rather glibly about a free health scheme but it. is not free. Someone has to pay for it. Either it is paid for by the individual under a voluntary scheme or it is paid for by the taxpayer under a compulsory scheme, but it is paid for just the same. It is a false approach to lead people to believe that under any scheme you get something for nothing. At least under a voluntary scheme there is some control because a person has to meet some of the cost involved. Under a scheme such as is proposed by the Labor Party where a person has to meet none of the cost there is always the great danger - this has happened in the United Kingdom - of over-servicing.
It is very easy to claim that the scheme which the Labor Party put forwardin its amendment, which it suggests should be adopted, will meet all the needs of the Australian people at low cost. During the last election campaign I saw the figures which were produced by the Leader of the Opposition in another place, Mr Whitlam -
Senator Murphy is not here so I am careful to refer to the Leader of the Opposition in another place - and they were challenged immediately by the Department of Health as being incorrect. I will not argue who was right but I believe the fact that the figures were challenged shows the importance of costing these schemes. When referring to the Labor Party’s scheme we must be careful about that to which we are referring. Medical and hospital services are different. If you include all the ancillary benefits which some people have suggested at some stage should be included you have a different problem again. So there will be a different costing. I do not think there is anything specific that we can really argue about as to the cost of the respective schemes because not enough is known of the costing of the Labor Party’s scheme. Certainly there is a very wide divergence between the costing by the Labor Party and the costing by the Minister for Health.
As Senator McClelland mentioned, in recent times 2 committees have examined the health scheme. I think it is only natural that any scheme introduced a number of years ago will start to show faults and weaknesses because of developments in medical science and in other fields. The 2 committees which examined the scheme highlight the advantages of regular examination of these schemes instead of waiting for 16 years, or whatever the period may be, to try to ferret out the weaknesses and faults that have developed in them purely as a result of the effluxion of time, changed economic circumstances and advances in medical science. It is also true that both committees found rather serious weaknesses in the present scheme. Senator McClelland has dealt with some of those and I do not attempt to deny them. They were there and this Bill is an attempt - I think a very good attempt - to remedy many of the weaknesses which have developed.
One of the problems to which Senator McClelland referred - this was reported on by both the Nimmo Committee and the Senate Select Committee - was the very high and unnecessary management expenses being incurred by some of the funds. I do not think that anybody can justify the high administrative expenses which some of the funds seem to regard as necessary expenditure. I believe that this is one of the greatest weaknesses in the present scheme.
The Commonwealth Department of Health has certain powers over health and medical benefit funds, but I think it is fair to comment that it appears to be reluctant to use these powers. The Department of Health has relied upon persuasion to influence those funds whose expenses are far too high to reduce them, but I do not think that this approach has been successful. I think the funds have gambled on the fact that the Department of Health has not been prepared to use the ultimate powers it has. Of course, there are good reasons for not doing so. It could result in disenfranchisement of a fund, which would be detrimental to its contributors.
The Senate Select Committee on Medical and Hospital Costs, of which I was a member, recommended a considerable tightening of the National Health Act to give the Department far greater control over funds by way of imposing far greater penalties. I am happy to say that provision has been made in the Bill which is before the Senate to increase the penalties. The threat of suspension has been clearly written into the Bill and it provides that action can be taken against officers of funds who do not obey the instructions of the Department of Health in regard to taking action when management expenses become too high. I believe that it is very necessary for the Department of Health to exercise far greater control over the management expenses of many funds. I think it is worth looking at the report of the Nimmo Committee in this regard. The report states at page 45 in paragraph 1 1 .2:
In the financial year 1967-68 the lowest expense rate for hospital funds was 6.2% of contribution income and the highest was 20.24%.
There is a tremendous difference between 6.2% and 20.24%. The report continues:
Most hospitals funds’ expenses were within the range of 11% to 13% of contribution income. Dealing with medical funds, paragraph 11.3 of the report states:
For medical funds the lowest expense rate for 1967-68 was 10.86% of contribution income. Most medical funds’ expenses were within the range of 14% to 16% of contribution income. The highest expense rate was 21.29%.
The Nimmo Committee went on to point out in its report that there is always some difficulty in judging the exact differences in management expenses because of the different systems of accounting which arc used. Nevertheless, the Nimmo Committee found a tremendous difference in the management expenses of some funds. The Senate Select Committee found exactly the same thing. It was very critical of the high administrative expenses of some of the funds because they are to the detriment of contributors. This was found to occur principally in the States of New South Wales and Victoria. I am happy to say as a Western Australian that the Hospital Benefit Fund of Western Australia has by far the lowest management expenses in Australia and it would appear to be the most efficiently controlled fund.
One of the reasons for the high administrative expenses - I think Senator McClelland mentioned this fact and the evidence points very strongly to it - is abuse of the competition which has developed between funds in New South Wales and parts of Victoria. Indeed, evidence which was given to the Senate Select Committee indicates that whenever one of the major funds in New South Wales has established a branch office in a country town in that State the other major fund has promptly followed suit and they have followed another around New South Wales like Brown’s cows. Plenty of evidence was also given to indicate that some funds are engaging in wasteful advertising. I think the members of the Senate Select Committee were all very critical of this type of wasteful and unnecessary expenditure. I am finding myself using the same language as Senator McClelland used, but I think that a great deal of criticism should be levelled at some of the funds for engaging in this type of expenditure. This is a weakness in the present scheme. I hope that the Department of Health will not hesitate to use its powers to control the expenditure of funds, including, as the last resort, its ultimate power of suspension. However, it should always have regard to the interests of the contributors. This is a recognisable weakness.
Senator McClelland criticised the number of funds which are in existence. I think it is fair to comment that the Senate Select Committee examined this matter very closely and formed the opinion that the existing funds should be allowed to continue because a good deal of healthy competition - I use the words ‘healthy competition’ advisedly - between funds with contributors having a choice is a good thing overall, providing expenditure is always strictly controlled. Indeed, many of the smaller closed funds - the industrial funds and so on - perform a most valuable function. Their benefits are very much higher than those of the large open funds. Some of the open funds objected to the existence of the closed funds because they felt that the closed funds were able to pick and choose their contributors. I think that the Senate Select Committee was of the opinion that overall this objection was unfounded. The Committee was of the opinion that the number of closed funds could be increased. It was of the opinion that it would not be a bad thing if many of the industrial corporations established these funds for the benefit of their workers. Indeed, it found that many employers carried on a coverage when an employee ceased working in the industry. Therefore, I do not accept the view and the majority report of the Senate Committee did not accept the view that there were too many funds. Perhaps the Committee would have been prepared to place a limit on the number of open funds, but it would not place a limit on the development of closed funds.
Another matter on which I find myself in agreement with Senator McClelland - indeed, both the Nimmo Committee and the Senate Select Committee found themselves in agreement with him - is in regard to the amount of reserves held by funds. On every piece of evidence the reserves are far too high. Both committees recommended that the reserves should be reduced, which would be to the advantage of contributors. I hope that this will be done because there is no doubt that the amounts held in reserve have reached the stage where they are unnecessarily high. Therefore, it would appear that there are grounds for criticism of the health scheme at present, particularly in relation to the operation of health and medical benefit funds.
Another matter of concern is the level of under-insurance or non-insurance. Both the Nimmo Committee and the Senate Select Committee had great difficulty in finding an answer to this problem. Senator McClelland was critical of the inequitability of a fund which allowed the wealthy not to insure and to gain tax concessions for medical costs. Here again I think there is a difference of philosophical approach. We on our side believe that a person has a right, if he wishes to take the risk, not to insure. That is his decision. The problem was with those who could not afford to insure or who could not afford to have an adequate insurance cover.
This real problem has been met to a considerable extent by the Government’s decision to insure these people. I am not prepared to argue whether this is Labor Party policy or not. Perhaps some aspects of Labor Party policy contain some good. But our scheme will cover these people who are an element in voluntary health insurance which poses a problem which should not exist any longer. These people also pose a problem for the great public hospitals in Australia because the indebtedness of the hospitals is due to people who cannot afford to meet their hospital expenses. Therefore, indirectly, the new scheme should have a beneficial effect on hospital finances throughout Australia.
I deal very quickly now with some of the problems which have arisen in relation to the proposed scheme. I refer to the establishing of a common fee. I believe this same problem would have occurred had the scheme been the Australian Labor Party’s scheme or the Government’s scheme. No Government can continue to subsidise doctors who have a right to set their own fees at any level which they wish to choose. Had it been the Australian Labor Party’s scheme or the proposed scheme, this problem in relation to common fees would have arisen. It would appear overall that the medical profession and the Government have reached an amicable agreement. The agreement is to be reviewed. Any basic weakness in the discussions between the Commonwealth Government and the medical profession on this matter would have occurred had Labor policy been adopted. I do not think the finger can be pointed at the Government and I do not think it can be said that the weaknesses of the scheme brought about an unseemly wrangle.
No doubt members of the medical profession are individuals, as are farmers, who cannot agree among one another on anything. That is both a weakness and a strength. Probably it is a weakness in the medical profession and a strength among farmers. I do not know. I think both groups have that in common. There has been a great deal of dispute between sections of the medical profession over the differential rates. I think all honourable senators have been bombarded by submissions from general practitioners and others.
– I thought all members of the medical profession were farmers.
– I think Senator Prowse has raised an interesting point which perhaps should not be developed in this debate but which could be discussed at some other time - the possibility of the medical profession turning to farmers and the possibility of farmers turning to doctors. I think that if that situation arose the same problem would occur because farmers would not agree as doctors and doctors would not agree as farmers. 1 think we would still have the same problems. 1 recognise that, among a section of general practitioners, there is a fear that the differential rates proposed by the Government would cause them many problems. I am also aware that only a section of the general practitioners are expressing this fear. Many others - if the information I have is correct, the majority - are prepared to accept the scheme and see how it works. The Minister has promised at the end of the year, I think, a review to see whether the general practitioner is being harmed.
A system of referrals is to be introduced, I think by regulation. That system will be similar to the one that exists today. I think that under the proposed scheme a system very similar to the one that exists today will occur. Only on a referral to a specialist will the full rebate be obtained. However, I recognise that there is some uneasiness among general practitioners - an uneasiness which I do not share at this stage. I suppose it is always a good thing to bark or to howl before one is hit. I do not believe that because some are barking before they are hit the Government should be influenced. The objective of the Government is to give the maximum cover to those who need it. I think that is one objective that all honourable senators would support. Whilst recognising a fear among general practitioners, I do not believe this fear will be proved to be justified. This will be particularly so if the State governments accept - and I think one State has accepted now - a register of specialists. It appears that at the moment - and we have evidence to this effect - some doctors practice as general practitioners in the morning and as specialists in the afternoon.
I think it is generally agreed - certainly by the Australian Medical Association - that only those with the necessary qualifications should practice as specialists. If a register of specialists is set up in each State, one rather thinks that some of the problems feared by the general practitioners will not arise. I do not think I want to say much more about these fears, but before I leave the subject I think it is worthwhile to study what the Minister said with regard to this problem of general practitioners as against specialists. A joint Press statement issued by the Commonwealth Minister for Health and the President of the Australian Medical Association said:
At the meeting the AMA representatives reaffirmed. . . .
This was the dispute within the medical profession -
That is what I have said. The joint Press release also said:
The Government is convinced that these arrangements, which have the support of the Australian Medical Association - the profession’s official negotiating body - and which were recommended by the Nimmo Committee, are necessary in view of the medical profession’s own long-established policies and fee-charging practices, lt is considered that the provision of differential benefits is essential for the security of contributors against the actual costs of medical treatment.
Here I think we are placing above all the security of the contributor. Surely this must be the aim of any legislation or scheme. There is a measure of agreement between the Government and the AMA. Whether the AMA is speaking for all the medical profession is open to question, but it is the official negotiating body. There is a measure of agreement between the Government and the AMA on differential rates which agreement is opposed by some sections of the profession. I think we have to wait and see whether the general practitioner, whom we all accept is the very basis of any hospital or medical scheme, is not disadvantaged by these differential rates. If he is, it will be necessary to take action to protect him.
I think 1 have spoken long enough to indicate my support for the Bill. 1 express one regret. I think the Government might have taken into greater consideration the report of the Senate Select Committee which differed in some major respects from the report of the Nimmo Committee. The final decision rests with the Government. It may well be that the Government took the findings of this Senate Select Committee into consideration but no acknowledgment of this has been made by the Government. I think it is unfortunate that a committee of the Parliament should be ignored. I support the Bill before the Senate and I oppose the amendment.
Senator McMANUS (Victoria) 14.15]- The National Health Bill 1970 has now reached the Senate, but not without blood, sweat and tears. The Australian Labor Party has moved the following amendment to the motion for the second reading of the Bill: but the Senate is of the opinion that, while the Bill represents some improvement, a National Health Insurance Commission financed from graduated contributions would pay for medical and hospital services for all more equitably and economically.
That amendment constitutes a quite innocuous expression of opinion from the principles of which my Party does not dissent. But the Australian Democratic Labor Party feels that the amendment is not adequate to deal with the present situation. We all know from the extraordinary amount of lobbying which has gone on within these precincts that at the present time grave differences of opinion exist between sections of the medical profession. My Party feels that it is in the interests of our country that those differences of opinion should, if possible, be resolved by further negotiation. In order to allow time for such negotiation and discussion the Democratic Labor Party moves the following further amendment:
Leave out all words after ‘thai’, insert -
In view of the fact that:
it is desirable in dic national interest thai the National Health Bill find maximum possible acceptance from all interested parties;
negotiations within the Australian Medical Association between various groups in that body have noi yet succeeded in reaching an agreement; and
for the purpose of endeavouring to reach such an agreement a meeting of the Association has been called for 2nd and 3rd June, at which the Federal Assembly of the Association will make a final endeavour to arrive at a formula acceptable to all branches of the medical profession and which will not be contrary to the interests of those who will benefit from the Bill, further consideration of the Bill bc postponed until the outcome of this meeting is made known to the Government’. 1 have in my hand a copy of the agenda for the ninth federal assembly of the Australian Medical Association which is to be held in New South Wales from 1st June to 3rd June. The agenda contains a number of propositions which have been put forward with a view to determining a basis for agreement between those sections of the profession which, at the moment, are at odds. Obviously any scheme such as this depends upon its willing acceptance by members of the medical profession and, if we may hope for it, a united approach. It seems to me highly desirable that the Government should await the decisions of this important assembly before proceeding further with the Bill.
I wish to make some general observations in regard to the Bill. 1 said earlier that my Party would not dissent from the proposition stated in the amendment moved by the Australian Labor Party which calls for a National Health Insurance Commission financed from graduated contributions because for a long time the Democratic Labor Party’s policy has been for a comprehensive national insurance policy on a contributory basis to cover sickness, accident, unemployment, death of a breadwinner, and old age. This Bill affects, of course, one of those matters, that of sickness. Until the time when the Democratic Labor Party’s proposition can be accepted we of that Party accept the present situation in which hospital and medical costs are covered by private, voluntary insurance schemes, with Commonwealth contributions for hospital treatment. We are glad that the Government has taken action to place the position of these funds upon a better basis. We realise that over the years the system has suffered from very serious weaknesses and omissions. For a long time hospital and medical charges have been rising at about 3 times the rise of average male earnings. The schemes do not cover dental expenses and there has been grave criticism of the amount of contributions because, in some cases, from 13% to 15% noes in administration costs.
A feeling has existed that Australia ought to be more generous if it seeks to deserve the title of a socially progressive country. 1 took out some figures some years ago which showed that expenditure on health services as a proportion of national income was 7.5% in the United States, in Israel 7.4%, Canada 7.2%. Chile 6.8%, Sweden 6.2%, Australia 5.8%, and the United Kingdom 4.9%. In my Party’s view Australia could have been more generous in regard to these services. But there was another factor which occasioned us grave concern. It appeared that the groups in the community which most needed assistance in these matters were frequently not in a position to take advantage of them because of the cost of insuring for benefits. A survey which I and others studied in my own State of Victoria a couple of years ago showed that of people earning over $4,160, 87% were covered by hospital benefits; of people whose incomes were between $2,028 and $4,160, 75% were covered; but of those who were earning less than $2,028 only 54% were able to take advantage by contributing to the hospital benefits scheme. Over all, 69% of wage earners were contributing, but I repeat that it is most disturbing that those in the lowest income groups were least able to take advantage of these benefits. We have all noticed the considerable increase in the cost of hospital treatment over the years and, allied with the other factors to which I have referred, all this has made it extremely necessary for the Commonwealth Government to take action.
My Party is glad that the Commonwealth has taken action and we look forward to the day when the Government will go further and produce an even more comprehensive scheme for the social insurance of its citizens. I must apologise that copies of my amendment have not been available but they are available now and will be distributed. The Bill, therefore, under my amendment will proceed to the second reading. The amendment proposes a halt to allow the Government to learn the result of the efforts of the Australian Medical Association assembly to arrive at a basis satisfactory to all. That basis will be known to the Government within the next couple df weeks. I believe that there is every reason for the delay. I have heard suggestions that this Bill must operate from 1st June. I do not know the reason for the urgency when there has not been any urgency in dealing with this situation over the years.
– Fifteen years.
– If it has taken 15 years to get to this stage I do not see why we should be high pressured into getting on with the job when we have only received the Bill within the last couple of days. I have been impressed by the large amount of evidence that has been placed before me that this Bill, if implemented as it stands, may have very serious effects upon a very important section of the medical profession, that is, the general practitioners who, I am informed, constitute 40% of the medical profession in this country and who, if I am to judge from the number of them who have got in touch with me individually and in a representative capacity to protest against the Bill, regard its provisions as seriously threatening their future. I believe that there is abundant evidence of the truth of their claim that if the Bill is passed as it stands it will discourage young medical men from undertaking one of the most important duties in the community, the duty of the general practitioner.
The general practitioner is important in the towns and cities but he is particularly important in the country areas. We are all familiar with the difficulties that have existed in the past few years in many country areas where people have had difficulty in inducing a general practitioner to reside in their area. With all the evidence that we have of the serious effect that the Bill as it stands could have on the situation of the general practitioner I feel that we have to be concerned over what may happen. I feel that this could seriously discourage members of the medical profession from going into that field. I am informed, and I believe what I am told, that there are already signs of a falling off in the number who are prepared to undertake that career, and in those circumstances I would not be prepared to do anything which would so gravely prejudice the position of the general practitioner that within a few years we could be deprived of what is a most important element in our medical community.
I have seen and I have read carefully the statements that are made in regard to the question of differential rates. I think the general practitioner has a legitimate grievance and I think that there are indications of injustice and ineffectiveness in a number of provisions that have been inserted in the Bill. In those circumstances it seems to me that this is pre-eminently a Bill that should be held over until the members of the profession themselves have had an opportunity to look at it. I believe that the amount of discussion that has gone on among them in recent months must have an effect in inducing them to reach acceptable agreements and compromises. I, for one, because 1 feel that it is vital that the position of the general practitioner should not be prejudiced because he is most important in the community, believe therefore that we should hold this Bill over for a couple of weeks until the Australian Medical Association has reached a determination and then we will be able to go on in a much better situation to reach a decision. I hope nobody will suggest that this is just an attempt to induce further delay and to further hold up the implementation of the Health Bill.
So far as the general provisions of the Bill give a better deal for the ordinary member of the community my Party fully supports it but we say that this is a case where haste is not justified and when negotiations ought to take place. 1 suppose we have had an outstanding example of this in this Parliament in the last week, where something was embarked upon in haste and, I understand, this morning a decision was made not to go further but now to embark upon negotiations. I hope the opportunity will be taken at this point to let the Australian Medical Association at this important assembly on 1st June discuss the matter and seek to arrive at a decision which will be acceptable to all the parties. There are a few more matters which will probably be discussed during the Committee stage. My Party is not happy with the proposals for very important actions relating to this Bill to be taken by regulation. We are always suspicious of proposals to that effect and we will examine very carefully those provisions before deciding our attitude. We believe that the claim of the ophthalmologists for the remedy of a provision which they claim is unjust and inequitable from the point of view of the ordinary member of the community is justified and we will support the amendment which will be put forward in the interests of the ophthalmologists.
I will not delay the Senate any further except to say once again that any health scheme must depend upon the willing cooperation of the medical profession. There is no more important section of the medical profession than the general practitioners and if by waiting a little and by allowing time for cool discussion and negotiation we can reach a point - or we can hope to reach a point - where all sections will be satisfied, we ought to be prepared to do that. I therefore commend to the Senate the amendment of my Party in which we say that further consideration of the Bill should be postponed until the meeting of the assembly of the Australian Medical Association has arrived at decisions and communicated them to the Government, the meeting to be held on 1st, 2nd and 3rd June.
– 1 second the amendment.
– I rise to support the amendment moved by my colleague, Senator McClelland. When he launched his amendment he was in the happy position of having been a member of a committee that had been able to lift the lid from some of the machinations of the various health funds that have masqueraded as public benefactors. Senator McManus made a point as far as the Australian Medical Association was concerned and I accept that it would be Hamlet without the prince if we did not have the viewpoint of the medical authorities being considered. On the other hand the Government’s solicitude seems to be directed towards the future operations of the funds as they exist at present. I would like to make a few points in relation to the average subscriber. I thought 1 could start on no better point than to turn back the pages of history and refer to the opening speech of the then Minister for Health, Sir Earle Page, way back in 1953. He said:
A national health scheme, lo be permanently successful, must be much more than can be slated in figures or money.
When we have a look at the Nimmo report and all the Press handouts from the various funds it amazes me to see the amount of money held in reserve by these funds. Senator McClelland in his usual lucid style indicated the massive aggregation of reserves - S80m or more. There has been no attempt by the Government to issue any edicts to make these funds live off their own flesh. In referring to the Bill which the Minister for Housing (Senator Dame Annabelle Rankin) has produced the Government says that there is to be a new scale of tables, that there is agreement with the doctors, that there is now a big schedule relating to operations and that everything is going to be lovely. It is beyond my comprehension to reconcile that with the remarks made by Sir Earle Page about ethics. The classic illustration that I can give about the lack of moral values in the existing fund structure is by reference to a question which I asked in this place on 17th March. I asked:
With reference to the entry in the Hospitals Contribution Fund of Australia Report and balance sheet which shows an item of $500,000 - Public Hospital Loans, what are the details of these loan transactions. . . .
Then we hear the story of the hospital and medical funds as told by Mr Turner who says what a public benefactor he is. He says that the funds have lent $500,000 to public hospitals. But although I asked this question in March, it is now May and no one has been able to tell me to which hospitals money has been lent and why it was lent. But this is no cause for wonder because we all remember that a benefits funds in Sydney, without consulting its subscribers, purchased a light aircraft which crashed. They have not bought another one, so apparently they were quite satisfied that public opinion was not with them.
– You are too fair to them.
– That is right. I want to hammer the point about fund democracy. Since i have been in the Senate 1 have listened on numerous occasions to remarks about compulsion in industry. It has been said that if a person goes into an industry where there is either compulsory or preferential unionism he is entitled to know how his union operates. There is no need for me to go on about the Industrial Registrar and the conditions that he lays down for the efficient operation of a trade union. But let anyone try to get the inside details about the medical benefits funds and see how he gets on. The funds are always late in publishing their balance sheets. No ordinary person has a right to stand for office with the funds. They have their exalted board of directors. All that I am saying is more than confirmed by a reference to the report of the Senate Select Committee on Medical and Hospital Costs, of which Senator McClelland was a member. At page 15 of the report under the heading ‘Commission payments’ paragraph 74 states:
The Committee concluded (hat this is an area of registered organisations’ operations which provides an opportunity for competitive practices detrimental to contributors’ interests.
During the last 3 months we have heard about these summit talks between the medical profession and the fund organisations, but nobody has mentioned that anybody from the bureaucracies which masquerade as funds has been brought to account. In the document which the Minister has produced in this chamber there is some reference to the funds being virtually, for want of a better term, reregistered. Apparently it is very nice at times to deregister a trade union, but 1 have not heard of any of these funds being deregistered. lt may be argued - I support this point to the hilt - that there should be some compulsory amalgamations of fund organisations. But leaving all that aside, the plain fact of the matter is that even if for the purpose of discussion we accept the argument advanced by the Government that everything is going to be all right on the medical side - I do not accept it. and neither does any member of the Opposition - the Government is still running away from the fact that hospital costs are increasing. The New South Wales State Minister for Health, Mr Jago, contends that they are increasing by 10% every year. If we consider the average citizen in this country, at some time during his life he or she, or some member of his family, will suffer from an illness. At that time he is not going to make a distinction between the doctor and the hospital when it comes to meeting his bill; to him it will be a debt which has to be met. But the Government has not faced up to this situation.
On the first page of the second reading speech delivered by the Minister for Housing she referred to ‘basic principles which the Government believes are essential in any national welfare measure’. If we harken back to what was said by Sir Earle Page when he introduced the first of these schemes we see that it was patterned on the
United States Blue Cross scheme. Anyone who has followed the American health system, particularly over the last 3 years, and considers it, even with the injection of the medicare scheme, will appreciate that the whole weakness of the scheme is its excessive fragmentation. This is what is happening in Australia. No attempt is being made to bring about compulsory amalgamation. We will continue to have this excessive competition between the medical benefit funds. Senator Rankin, who is the acting Minister for Immigration, will appreciate what I am now about to say.
We had a situation in the late 1950s in New South Wales when I was a union official in which migrants, when we wanted to enrol them in a union, would say that they were in a union already and would produce a brochure from one of the medical benefits funds to show that they belonged to that fund. This was the result of the high pressure salesmanship that went on. As Senator McClelland has reminded me already, there is another reference to this point in the Nimmo report in section 11.7 where excessive salesmanship is referred to. The thing that annoys me is that when we get this talk about law and order - I am sorry that Senator Greenwood is not in the chamber to hear this - we get also this double standard that the Canadian Prime Minister spoke about yesterday. We find that some poor unfortunate individual who has tried to swindle society over some some small amount is hounded and dealt with; but when we come to the big people we find that this never happens. There is a man serving time in Long Bay gaol at the moment. I refer to a Mr Huxley. He was a friend of Mr Turner’s and nobody worries about anybody moving along on that line. They swindle on a top note.
My criticism is that the whole box and dice of the Bill now before us emphasises what the Australian Medical Association thinks and what the funds think, but nobody mentions what the average individual might think. To prove this point I propose to quote from ‘Membership of Voluntary Health Insurance’ by R. B. Scotton. It will be recalled that this gentleman was referred to extensively by my leader, Mr Whitlam, and by my leader in this House, Senator Murphy, during the last election campaign. The general response from the people showed that as a whole they were pretty fed up to the teeth with the continuation of these privately sponsored schemes which provide only costly edifices in the capital cities and do very little for the person who is battling. Page 79 of this report by Mr Scotton deals with the types of people who are strongly inclined towards voluntary membership of medical funds and those who are the reverse. The report shows that those strongly inclined to voluntary membership are aged 65 years and over with a weekly income of $80 or more and single females aged 25 to 64 years. Then it deals with other categories. It then mentions those who do not join the funds. Among them are migrants of less than 5 years residence, single males aged 25 to 44 years, and then it deals with other categories of migrant.
A further subdivision of that number is mentioned at page 71 of the document. At that page we find that in Melbourne in 1966 a survey of living conditions was conducted by the Institute of Applied Economic Research which took out a sample of 4,698 income units which were defined as representing the non-pensioner, noninstitutional population of Melbourne at that time. Of that number of income units 22.1% containing 17.3% of persons had no insurance cover or public entitlement to free treatment. I should like to relate that figure to the males aged 25 to 44 years. I speak with some feeling on this because I would say that these people are far better off than people who have joined funds but who have had a good run for 15 years. The Minister is familiar with my own particular case in respect of which I wrote to but did not receive the courtesy of a reply from the Federal President of the AMA. I had been a member of funds for 15 years and then had a minor operation to my eye. I give credit to the doctor who removed a cyst. It left my sight unimpaired. After contributing for 15 years and paying my bill for $32.80 I received $6.50 from the fund. That meant that the fund had made a walloping big profit from me, as it must have done from a number of other people. I would have been better off if I had not joined a fund. The Government now has the temerity to tell me that I, like many others who receive a smaller salary than I am getting, have to insure now at a higher rate of contribution. I guarantee that within 2 years the Government will be saying that it has satisfied the medical profession and it is wondering what it will do about hospital costs. We hear talk about the 1970s and about the great mineral discoveries in Australia, so there are many ways in which increased costs could be met.
Instead of giving us 6 pages of drivel - that is all it is - the Minister should call representatives of the funds before him and say that they will be nationalised if there is not an amalgamation. Mr Turner would be grovelling at his feet if that were done. The whole trouble is that the funds are organised whereas the average subscriber is not. Senator McClelland dealt in great detail with our proposal for a national health insurance commission. There is very little talk about that from honourable senators opposite, because an individual without shares in the health funds would stand up Mr Turner and all those other czars of the funds. I am sick of listening to double talk and the solicitude for the medical profession, but in saying so I am not referring to the rank and file members of hospital and medical funds. I certainly would be the last to deny the vital role of members of the medical profession, but all that the Government is doing in this Bill is trying to placate the medical profession on the one hand, and the health funds on the other hand, instead of issuing orders to the funds to put their houses in order through compulsory amalgamations. I would think that that would be only a half-way measure even then.
I referred earlier to males in the 25 years to 44 years group engaged on public works projects and other big construction jobs. Obviously they spend a lot of time in transit. They are fellows who are in reasonably good health. If they had 1±% of their wages deducted and paid into a fund such as we suggest, by the time they reached their forties they would have the comfort of knowing that they would be completely covered for any illness. That is not so under this legislation. All honourable senators have had experience - and. honourable senators opposite will admit it if they are honest - of being approached by people and being regaled with examples something like this: A man is told that he is suffering from appendicitis. Later he is told that his illness is in the grey area. It is not quite appendicitis; it is a sort of semi-hernia. I appreciate that I am getting down to a rather banal level now and I apologise to the Minister for that. A lady came to me the other day and told me about a recent confinement. She told me about the birth of her baby and one or two minor aspects of surgery that were necessary. 1 will gloss over them. Often a fund rules that an illness is not in a particular category. It is all very well for the Government to produce a booklet and a table containing many medical terms. Nobody can convince me that this table will mean anything to people who suffer from borderline ailments, or crossfertilisation, which I think is the in term at the moment.
It does not matter how high the table reaches. What is important is the impact on a person who has contributed to a fund for years to cover himself and his family. Honourable senators opposite might say that although an operation costs $400, up to 80% of that cost is refunded. But it is the other 20% that hurts. A contributor still feels that he is being stung. The Government has instituted numerous inquiries. I would be much more satisfied with this legislation if the funds had squealed about it. The Government never chastises the funds. Recently the banks decided that certain charges must in future be paid by organisations such as little debating groups and local horticultural societies. Some of the banking services are no longer to be allowed free to them. They rightly were critical, but the greatest squeal of the lot came from a spokesmen for the medical and hospital contribution funds. The first reaction of the funds was that that was a reason to increase contributions of members. 1 do not know how that idea could be squared up with vast reserves totalling about $8()m referred to by Senator McClelland. It highlights my point that the Government has adopted a namby-pamby attitude towards the big shots who operate the funds.
On some occasions it can rightly bc said that beggars cannot be choosers. 1 have no doubt that the Minister will tell me that some concessions are to be granted to people on low incomes. That is all right up to a point, but some people are on low wages, perhaps for 6 months, and then through overtime earnings enter a higher income bracket. Suddenly they will find that they are priced out of the scheme. We are debating health matters, but the plain fact of the matter is that we should bc concerned about such people who today receive average margins above the basic wage.
Their beef is that although they receive a wage increase, within 6 months costs have spiralled. The Government does not believe in price control or food stabilisation or subsidy schemes. In the final analysis, whatever wage a man is receiving, he may reach the stage that he cannot pay for health insurance because of competing demands on his limited wage packet.
Our objection to this legislation is that it is inadequate. Senator McManus has indicated that the medical profession may reach agreement with the Government, but too many questions are unanswered. We have offered a wealth of criticism in the past about the administration of the health funds. That criticism has never properly been answered. The funds were supposed to contribute so much towards public hospitals, but we have heard nothing at all about that. On this occasion the Government might have introduced a new code. My colleague in another place, the honourable member for Prospect (Dr Klugman), is a very illustrious member of the medical profession. He put some searching questions to Dr Forbes about the directors of the Medical Benefits Fund of Australia. He made strenuous efforts to get information but he had as much chance of getting that information as he had of finding out what goes on at Pine Gap, because of the security embargo that the Government places on particular matters relating to the health of the community.
Even if we accept that this legislation is the best the Government can suggest, it does not help to solve the problem of hospital costs. Senator Cormack, who is an avid reader of ‘Newsweek’ and ‘Time’, will have followed these issues very closely. The Blue Cross system of health insurance was pioneered in the United States but it is now admitted there that fragmentation has occurred. It has happened there, as it has happened here, that sections of the medical profession - as Senator McClelland said - would prefer to have no health insurance funds at all than to have greater government supervision. The law must apply equitably to all, irrespective of whether they are professional men or workers on the workshop floor. Irrespective of the political colour of a government, it has to devise an effective health scheme. We have referred to the health schemes in force in Britain and Scandinavian countries.
Government supporters have referred to the mounting costs of those schemes, but the truth is that in Britain the people are virtually covered for medical and hospital costs from the womb to the tomb. That is not the case in Australia and it is of no use for honourable senators opposite to run away from that situation.
I have referred to a small operation on my eye. After contributing for 14 years in good health to a fund I would not have objected if I had received a refund of 100% of the cost of the operation. In Britain and Scandinavia I would have received that refund, but here I was well and truly exploited. There is no question about it. Nobody has been able to answer satisfactorily that particular point. We have suggested a scheme to be financed by deductions of li% of wages. More money would be paid into a common fund and in times of a buoyant economy enough money would be available to allow a recasting of the system. The health funds in Australia have millions of dollars salted away in reserves. Nobody seems to have the key to open the safe to give that money back to the subscribers.
I hope that when the Minister replies she will be able to say to me: ‘Well, senator, if Si 00m is salted away, under our new table subscribers might pay 40% but we will make the funds live within one-quarter of the contributions by subscribers, and not one penny more.’ AH that the Government is doing is ensuring that the funds are not operated democratically for their contributors. The directors of the funds are able to have bigger and better board rooms. In Sydney they are erecting massive temples comparable with the Taj Mahal. The directors are interested only in creating big empires. I remind Senator Dame Annabelle Rankin, who represents in the Senate the Minister for Health, that I am speaking for many subscribers who are fed up to the teeth. They listened to the evidence which was given to the Senate Select Committee and have waited in vain to hear that the average rank and file subscriber will get a fair go - never mind the susceptibilities of the fund directors or the Australian Medical Association.
– I agree with Senator McManus - I believe that the Government does, too - when he expresses concern about the fate of the general practitioner under this revised health scheme. Speaking as a layman, I am one of those people who believe that the general practitioner is the very basis of the whole medical profession and certainly is the basis on which a national health scheme should rest. Without him we would have no medical foundation. We cannot envisage a medical profession in Australia consisting of nothing other than specialists.
I point out that this Bill was delayed for 3 or 4 weeks. Senator McManus would say that was not long enough. But I take it that during that period of 3 or 4 weeks the Minister for Health (Dr Forbes) had conferences with the people affected, including the general practitioners associations. It may be that as a result of those conferences it was agreed that claim forms be watched and that an attempt be made to ascertain a drift that takes place from the field of general practice, with a view to taking remedial action. I take note of the fact that the Australian Medical Association said that the drift might be so insidious that it would be impossible to detect by means of a perusal of the claim forms. However that may be, I repeat that I believe that that concern is shared by the Government and that it is a matter that needs to be watched closely because anything that is derogatory of the general practitioner pulls down the whole medical profession.
I take note of the amendment moved by the Opposition. As always, the Opposition proposes to institute a health scheme based on the graduated income tax scale. I was intrigued by what Senator McClelland said in this regard. He criticised the Government for setting up the Commonwealth Committee of Inquiry into Health Insurance - the Nimmo Committee. The Minister for Health set up that Committee to try to devise ways and means by which the health services of this country could be improved. It made certain recommendations - some of which are embodied in the Bill now before us - setting out various ways and means by which the health services of Australia could be improved. The Government has acted upon them. But Senator McClelland said that the Committee’s report was a glaring indictment of the Government.
So we are faced with this position: If we set out to remedy a scheme or to improve it and we do the logical, commonsense thing and set up a committee to investigate the matter and to bring forward recommendations, we are wrong; and if we do not do that or if we do not set out to improve the scheme, we are also wrong. So, we cannot win whichever way we go. For years past the deficiencies in the health scheme of this country - and there were deficiencies - have been pointed out to us on many occasions. It is to the credit of the Government that at long last, admittedly, it has taken remedial action in that regard.
It is something dear to the hearts of many people all over the world that when a health scheme is put into operation the very acme of perfection is to nationalise it and to charge the cost to the public on a graduated scale of income tax. These people seem to think that after we have done that we are well and truly on the high road to perfection. But in my humble opinion that sort of thing - as in the United Kingdom and as in Scandinavia, about which we have heard something this afternoon - contains within itself if not the seeds of its own destruction then certainly the seeds of mediocrity, inefficiency, dissatisfaction and discontent on the part of the people who are served.
A nationalised health scheme has been operating in the United Kingdom for 25 years, I suppose it must be. Some time ago I read that it would cost more than $ 1,000m to bring it up to the standard in most advanced countries. Furthermore, the United Kingdom has had committees reporting to the Government and setting out to devise ways and means by which the health services - the doctor services and all the rest of them - can be improved, lt has been a matter of very great concern to many people in the United Kingdom that there was so much leeway to be made up over recent years after the scheme had been in operation for a long time, not only in regard to medical services but also in regard to hospital services. Not long ago I read a report that was a scathing indictment of hospital services in the United Kingdom in regard to some aspects of medical treatment.
I am one of those people who believe that the solution does not lie in the nationalisation of health services. We have been told that the Opposition proposition would cost only an additional li% of income tax. I think that was the figure. But, whatever the figure was, if that proposition ever came into operation in this country and if I were a betting man 1 would bet 2 to 1 that the estimate would be exceeded, tat it would probably be doubled and at the cost would go on rising for evermore These nationalised schemes - especially nationalised health schemes - seem to have something inbred within them which means that the costs mount and keep on mounting until there is taxpayer resistance to them.
New Zealand is sometimes quoted as the very acme of the welfare state in which everything in the way of medical care, hospital care and all the other services is just as it should be. Not long ago I read a statement with reference to the free medicine scheme in New Zealand, lt said:
Emergency action is being taken by the Department of Health to combat very large increases in the cost of pharmaceutical benefits. . . .
An urgent call recently brought together the Department’s Pharmaceutical Advisory and Pharmacology and Therapeutics Committees to consider what action could be taken to reduce current expenditure on ‘free’ medicines issued under the social security scheme.
These ‘free’ things are uncommonly expensive, as a rule. The statement continued:
These committees arc understood to have made certain recommendations which are now being considered by the Minister for Health. . . .
Reason for the Department’s alarm is that the cost of ‘free’ prescriptions jumped by 26% from 1st April to 30th June compared with the same period last year.
If this trend continues, the current year’s medicine bill will be in the vicinity of £6,441,552 -a £1,329,209 jump over last year and £911,552 more than the estimated cost of ‘free’ medicine this year.
That is an indication of the difficulty with which the New Zealand people are faced. When I was over in New Zealand some time ago it was estimated that the cost of providing social services in the Dominion of New Zealand was more than 50% of total aggregate income. A lot of growling was going on because the government of the day did not reduce taxation. I pointed out to some of the people there that if it did not cut out some of the allegedly free things, the government had left only about 40% of the total aggregate income on which it could operate to bring about a reduction in taxation. By the time the government carried out its public works programmes and made provision for defence and other matters the responsibility of all governments, it did not have very much scope in which to effect reductions in taxation. These policies can go on and on until in the end they defeat themselves.
I know that a section of general practitioners has expressed concern about this Bill. I believe that it is a splendid Bill. I believe that it embodies those principles that tend to make the medical profession more and more efficient. It does not destroy the whole castle or pull the house down and attempt to erect something which of its very nature will not be as good. I believe that the ideal that this Government follows in providing medical benefit insurance is a good one. But I think, too, that the great point of concern about this Bill is its effect on the general practitioner.
– Do you think that the general practitioner is getting a fair deal?
– That remains to be seen. Some general practitioners seem to be content with the position. Of course, others are not content with the position. Some general practitioners fear the very worst about this measure. But I ask: Was not something happening to general practitioners before this measure was mooted? I read a statement by a doctor who said:
The present average age of the Australian GP is said to be 47 years. In another 10 years time it will be not far short of 57 years and 10 or 20 years after that, the GP will be as dead as a dodo, or nearly.
This was happening to GPs before this measure was mooted.
– What is a ‘dodo’?
– I do not know what a ‘dodo’ is, but it is a saying I have heard for as long as I can remember. The doctor went on to say:
I wonder who will care for the everyday sick, young and old in towns like these.
When he said that he was speaking about the show place of Australia - the north west coast of Tasmania. He continued:
Who delivers the babies in a doctorless town, picks the casualties off the streets and stitches the Sunday footballers? Who will rescue the asthmatic, reassure the frightened and steer the acutely ill to local or distant hospital? Who will govern the crisis of the diabetic, the therapeutic tight rope of the heart patient on anticoagulant drugs, the support of the patient dying of malignant disease?
Of course, all that is true but I repeat: There seems to have been something happening to general practitioners before this measure was mooted. Only 2 days ago 1 noted a newspaper cutting which said:
Victoria is experimenting with rural medical centres in an effort to overcome the isolation which is driving doctors out of country practice.
But, of course, it seems to me - and 1 am open to correction - that possibly it is easier for a specialist to concentrate on one thing and that the remuneration received by the specialist is greater than that received by the general practitioner. Maybe that has something to do with the present trend towards specialisation. But I would say, as one who does not know very much about it. that it would be a lot easier to concentrate on one aspect of illness than to be a general practitioner who is supposed to have an expert knowledge of all diseases. Whether that is the trouble or not, I do not know, but it is a position that needs to be closely watched, because I think it would be a sorry day for this Commonwealth if the medical profession, particularly in the smaller country towns, were left in the hands of people who specialised in only one particular type of disease. 1 believe that that would be an impossible position.
– The specialist would not be there, anyway.
– No, he would not be there. 1 said to my doctor: ‘What do you do when you have lo refer a patient to a specialist?’ He said ‘Sometimes specialists visit these towns. If they do not visit these towns then you have to send a patient a long distance away to see a specialist.’ A good deal has been said about the power of referral; that it will still be the general practitioner’s prerogative to refer cases lo specialists. 1 believe that that will be the case, that that procedure will still operate, although I think it is a fact that the Australian Medical Association has pointed out that in at least 2 States referral is mandatory if the patient demands it. However that may be, they are things which no doubt wilt be ironed out.
In my opinion no very definite concrete case has been put up yet which shows clearly and concisely that this Bill will do irreparable harm to the general practitioner. I may be wrong but I do not think I am. 1 repeat that that is a position which needs to be watched closely. Apart from that feature there is something else which has been driving young students out of a desire to qualify as general practitioners and into a desire to become specialists. That is something which needs looking into because, in my view, if that trend continues it will be a very bad thing for the medical profession in this country. I support the Bill.
– 1 will not make any excuses for taking a little longer than the normal time allotted for 3 reasons: Firstly, because this is a subject about which I know something; secondly, because I am not a (party to the Party Whips’ agreement; and, thirdly, the Party Whips never offer me time on the air anyhow. So if 1 take a little longer than half an hour. Mr Deputy President, you will have to forgive me. The point about this Bill is that when one tries to study it one is faced with this problem: ls the Minister for Health (Dr Forbes) a doctor? 1 have been asked so often whether he is a medical doctor. I want to assure the public that he is a Doctor of Divinity because when you look at the Bill you will see its close connection with the prayer of confession, I think it is called, in the Church of England Book of Common Prayer where it says words to this effect: We have left out those things which we ought to have put in, and we have put in those things which we ought not to have put in, and there is no health in us.
When one analyses the Bill one sees that that is exactly what has .happened. There are things in it which should never be in it and there are things that are not in it which should be in it. Yet the Minister tells us that this is a health Bill. He goes out to the community time and time again trying to denigrate the doctors by saying: ‘The Government is thinking of the interests of the patients.’ The interests of the patients be blowed. He is thinking of the interests of the Government in obtaining the electoral vote. That is all that this Bill does. He tells people thai this will be the solution of the problem, lt is no solution because it will cost more, lt will cost every person who wishes to contribute a lot more, and it will cost everyone else through taxation a great deal more too. So in both ways the people will suffer more.
– A great deal more.
– Quite. The prayer of confession then goes on to this effect: Spare thou them, O God, which confess their faults. That is one thing that the Minister for Health need not worry about because he will never confess his faults.
– It is a good thing that you do not.
– Perhaps it is but at least I will be spared if I do, will 1 not? Here we have a Bill which has pious hopes that it will suit the people - pious hopes because the Minister hopes that the public will be better off. How can the Government say that this Bill is in the national interest? Honourable senators on the Government side do not understand it. How many speakers have we had on one of the most important Bills that has ever faced this chamber - the National Health Bill? I think we have had 5. I am the second last. I think that the Government is trying to drum up a couple more of its supporters to speak on it. On other Bills of minor importance we have 20 speakers when we are on the air, but today no-one on the Government side wants to speak because the Government wants to rush the Bill through and get it settled before some election or other. The Government is not prepared to wait, lt waited for 15 years to raise Commonwealth benefits, and there would never have been any complaint about the voluntary insurance scheme if the Government had played its part. The Commonwealth benefit has remained static since 1954. I have pointed that out time and time again.
– So has the Government.
– All right. I do not want to get into a political fight. Since 1954 there has not been an increase in the Commonwealth’s contribution yet everything has gone up in that time. I have pointed out before that parliamentary salaries have gone up by 130%. The Government did not worry about that. The Cost of living has gone up by over 100% yet, as I have said, the Government’s contribution to medical benefits has remained static since it was increased by 30% between 1952 and 1954. It has not been increased since then. If the Government instead of waiting fct 15 years had done the right thing and had increased its contribution to SI. 10 as it intends to do now in relation to item 1 - the commonest example - there would have been none of the present discontent with medical accounts because the gap between an account and the rebate would not have been there.
The Commonwealth has not played its part with the result that there has been dissent throughout the community. The Government nearly was beaten and was no longer the Government because of this very fact. Let nol the Government say that the reason for that was external affairs. It was social services and the proposed health legislation which nearly sank the Government, so it has rushed in with this Bill and today we are told that we have to get it through before 1st June. It is the only electoral promise given during the last election campaign that the Government can fulfil. What has happened to the promise to reduce taxation? We are told to wait until the Budget, but when the Budget comes along we will not hear any more about it. Already I have heard inklings that taxation will be reduced ‘in our term of office’ which covers the next 2 years. The Government could not do everything that it wanted to do so it is trying to pin everything on this Bill.
These are short term proposals but they will have long term effects. I presume that the Government will not be doing anything about this matter for another 20 years so why must we rush it through before we have some clarity? The Government argues about the Australian Medical Association. I admit that we doctors are in trouble and that a lot of the fault lies with the AMA because it has not studied what the general practitioner wants. The result has been dissent in the profession. It must have been exceedingly hard for the Minister to find out what he should do when even the medical profession did not know. It was not until the Prime Minister (Mr Gorton) mentioned the $5 difference that the medical profession suddenly became aware of what had happened. We did not mind the common fee and we did not mind the differential rebate until the $5 came into it.
That then brought right into the limelight the fact that the Government is denigrating the general practitioner. It is saying now that a general practitioner surgeon who does an appendix operation will not be paid as much as will a specialist although he does the same job and does it just as well. Do not tell me that all specialists are good. There are variants in all professions. A patient can go to a specialist and be ill treated. That happens quite often. The general practitioners woke up to the fact that we were to be denigrated and, no matter what Senator Lillico says, the result will be that we will not have general practitioners. The Government is worried now about the shortage of general practitioners but there will be a greater shortage in due course.
I find the Bill extremely hard to study. If any person in the Commonwealth, apart from the Parliamentary Draftsman, can tell mc what is meant by the following I will be very happy to know:
Where a medical service rendered to a person includes a medical procedure that would, but for this sub-section, itself bc a medical service, that procedure shall, in respect of that person, be deemed not to be a medical service.
Honourable senators may laugh but there it is. We are expected to know and understand that. I know that the Minister will explain what it means but to anyone-
– I will.
– That is the Minister’s job. How is a person expected to know what that means? When one reads this garbage to anyone one becomes a laughing stock. It is so essential that we rush this Bill through in the national interest. In the national interest we will let a woman have a mammaplasty for $5. That is essential. We are also going to allow them to have their faces lifted for $5. Is there anything more absurd than to waste our money on face lifting when there are other things which are more important?
– Hair transplants.
– Yes. Face lifting comes under item 8037 in one of the Schedules to the Bill. The Government will have to pay $147 and the benefit fund will have to pay $98, but the patient who undergoes this luxury operation - it is only a luxury because there is no necessity for it - has to pay only $5. If a woman wants her breasts enlarged the Commonwealth is happy to do it at a cost to her of only S5. This is absurd. Anyone who has studied the Bill will realise what will happen. Under item 7921 the Commonwealth will contribute $96 towards the cost of a woman having her breast inflated. I am now looking at the wrong side of the House; I should address my remarks to the Government side. The benefit fund will meet $64 of the cost of this operation, which costs up to $150 or $160. But a woman can have such an operation for $5. The same situation will apply in regard to a face lifting operation. The taxpayers’ money will be wasted on operations of this nature, but the Government is of the opinion that they should be included in this legislation. I believe that operations of this nature should be omitted from the legislation. There is no sense in having in legislation which covers such a wide scope the provision that every operation will cost the patient only $5. It is said that the scheme would work if it had not been for the Commonwealth.
I have said that differential rebates should be abolished. It is agreed that all specialists should be paid more for the operations which only specialists can perform. But there are certain operations which both specialists and general practitioners can perform. In the field in which both can perform an operation there should be no differential rebate. Therefore, in the field in which only specialists perform the operation a differential rebate is not necessary. There should not be any differential rebate at all. The one fee should be charged for the service no matter who performs it. if a general practitioner performs the service he is entitled to the same remuneration as a specialist. Sir Clarence Rieger, who is the President of the Australian Medical Association, gave evidence to the Senate Select Committee on Medical and Hospital Costs. He was a general practitioner in the country. I asked him: ‘Do you think that your surgery was inferior to that of a person in Sydney or Melbourne?’ He would not answer my question. Of course he did not, otherwise he would not have done it. Yet he is now advocating that general practitioner surgeons should get less than specialist surgeons. What will happen in the country areas where there are only general practitioner surgeons? Why should they not be paid as much as the Sydney man? Are they not doing the same operation? Are they not doing it as well? Does a patient not put his faith in him just as much as he puts it in any other doctor?
I am trying to get through my speech as fast as I can. 1 come now to the question of common fees. There is nothing wrong with having common fees so long as they are not used as a schedule of fixed fees. We are quite happy with them provided a very simple thing is added - an updating or what could be called a review of the fees at least once very 2 years. Do not let me go into a long dissertation about arguments with governments. The AMA is still arguing with the Commonwealth Government about the fee for treating pensioners. Every 6 or 7 years or whenever it is we try to get a rise, we are unable to come to an agreement. We come to a sort of compromise conclusion but we have never come to an agreement. There will be no agreement. The Minister for Health says: Yes, we will review the situation. We have a plan”. The Government has had plenty of time to work out a method of up-dating fees. A simple one would be to tie them up with the cost of living. Tie them up with the salaries of parliamentarians and we will all be happy. At least we know that we will be paid. But do not give us the story that up to now the Government has not been able to find a solution to the problem of up-dating or reviewing fees, because no-one trusts the Government.
Look what it did to the chemists. I am not saying whether the Government was right or wrong, but the point is that it promised the chemists, who had not had an increase since 1961 - 9 years - that it would go to arbitration. The Government went to arbitration and the arbitrator said that he would give the chemists an increase. What did the Government do? It said: ‘We do not agree with the arbitrators method*. So out it went Although the chemists have not had an increase since 1961 they are still not certain whether they will get an increase. The same situation will apply in relation to the common fee. Actually, the common fee will be automatically up-dated because it is not a price control measure. It would be much better if the Government were to say that it will review the situation at least once every 2 years, which is a fair enough proposal.
The Government does not have a firm policy about referrals. It is a well established fact that the cheapest form of national health service is the general practitioner service. It is the basis of all national health services throughout the world. But in this instance when a referral system is wanted the Government does not know what to do. Everyone is putting up different ideas about such a system. There should be a distinct referral for each service. If the Government does not apply this condition it will find that its bills are astronomical. Suppose a general practitioner sends a woman to a physician. The physician can send her on to a surgeon, gynaecologist or ear, nose and throat specialist - or all 3 of them - without the woman having to go back to the general practitioner. In other words it would be done through the specialist. A person should be referred only by a general practitioner. I am not talking about pathology and radiology because they do not relate to consultations. They are straight out technical matters. But if a referral system is adopted it must be from the general practitioner to the people concerned.
The Minister for Health has said that this Bill is in the interests of the people. Both the Nimmo Committee and the Senate Select Committee agreed that physiotherapists should be included in these provisions. Therefore, why are they not included? Has the Government not had time to do so? Why have they been excluded? Whenever it suits the Government it says: The Nimmo Committee said that we should do this and therefore we are doing it’. But whenever it does not suit the Government it forgets about the other things which the Nimmo Committee recommended. What about the things which the Senate Select Committee recommended? The Government is so frightened of the Senate Committee that it will not even recognise it, but the Committee brought forward some very sensible suggestions. 1 wish to refer now to the Pharmaceutical Benefits Advisory Committee, and raise a matter which is causing great concern to not only the pharmaceutical industry - the chemists - but also the doctors. An anonymous committee of 6 doctors and a couple of pharmacologists was appointed by the Government from a panel. These people make the decisions and advise the Government on various matters of procedure, such as what drugs should or should not be on the pharmaceutical benefits list. Their decision is final. Let us take a look at this matter. There is nothing in section 101 of the National Health Act which says that the membership of the Committee shall be anonymous. There is nothing in the Act that says that the Committee shall not give the reasons for its decisions. When 1 rang up today I was told that this is a matter of policy. Therefore, it is Government policy. Therefore, it is the policy of the present Government. A different Liberal Government could be in office tomorrow and its policy could change. Why should the Government not change its policy? Every time the medical profession raises the question of the ludicrous actions of members of this Committee the Government says: ‘We have no power over them’. That is a deliberate lie. The Government has power. It has every right to say to that Committee What are your reasons?’ It has every right to publish the names of the members of the Committee. The Government has every right to publish its findings, but it does not. Because it is Government policy the Government will not mention its reasons. So the membership of the Committee remains anonymous.
Let me tell the Senate a few of the ludicrous things that the Committee has done because the public should know. I have mentioned them before. I know at least 2 of the members of the Committee and they are 2 of the most upstanding men in the profession. I have a high regard for both of them. 1 think they are excellent men. I think it is their association with the Commonwealth Department of Health which has made them a part of this ludicrous band of humorists.
I shall outline to the Senate some of the mistakes which the anonymous people who decide what we are able to prescribe have made but for which no reasons have been given. Firstly, I wish to refer to a triple compound tablet which the Department of Health wishes I would forget about mentioning. It is called Amesec. The Committee withdrew it from the pharmaceutical benefits list because it said that it was a triple compound product and as every human being differs the 3 ingredients in it should be varied for each individual. It did not matter than 95% of the population could take Amesec. The Committee threw it out. No reason was given for doing so. I asked the Minister for Health whether it was on account of the cost of it. He said that it was not. The Committee left a rival’s triple compound on the pharmaceutical benefits list. Apparently the deletion from the list applied to 1 product and not to another. Within a few weeks of deleting the product from the list, the Committee added a third. Can anyone follow the workings of that Committee? It deleted 1 product. In the end it gave its reasons because the Royal Australian College of General Practitioners was so incensed. Finally the Committee said that the ingredients had to suit each person. What did the Commonwealth Government do? It said that the doctor could write out in full the 3 ingredients and the chemist could put them into a capsule. The doctor has to spend time writing the 3 ingredients instead of writing ‘Amesec’. The chemist has to make up the capsule. The patient suffers. He could have bought 100 Amesecs for 50c. Now he is allowed only 12 at a time. If he could get 100 capsules it would cost him $4.50. That is another ludicrous position. The Government forgets all the time that every mixture that is ordered in any pharmacy is made up of 2 or 3 ingredients. Surely if this principle applied to triple compound drugs it should apply to triple compound mixtures. We cannot find out from this Committee why it has deleted Amesec from the list.
Suddenly aspirin is no longer suitable for the human body. Why? Because certain people took 60 or 80 aspirin tablets a day, which caused some side effect. It caused some bleeding. Suddenly aspirin is off the pharmaceutical benefits list because it is harmful. Big brother knows what is best for us. The Government deleted aspirin from the list. A doctor can order aspirin for pensioners. The Government does not worry about the pensioners. It does not mind if they die or bleed. The pensioners can have aspirin, but everyone else who wants it can no longer have it. Can the Government explain why? Can we ask for an explanation? Phenacetin was deleted from the list for the same reason. Stupid people who took 80 tablets a day had trouble with their kidneys. If they want to take 80 tablets a day I hope they have trouble with their kidneys. Obviously they have mental trouble, otherwise they would not take 80 tablets a day.
– Do you think the mental trouble might be improved by the kidney trouble?
– I do not know, I am sorry, but you are getting close to home now. Phenacetin was deleted. Doctors are allowed to prescribe a new drug called paracetamol’. It has now been shown that the end result from paracetamol is the same as the end result from phenacetin. I do not know what the Committee is doing about paracetamol yet. The Government has not told us. This is what doctors have to put up with with this Committee.
The drug companies have to put up with worse. They submit to the Committee a drug that they want evaluated and accepted so that the public can use it. lt is turned down. Why is it turned down? Nobody knows. The Committee is anonymous, says the Minister. The Government will not say. Should not the Government try to help the drug companies rectify their fault? Should not the Government try to help everyone so that these drugs can be put on the market? No! The Government does not say anything to anyone about them. Then we have the stupidity of the specified purpose drug. That term was cooked up by the Department of Health because it could not think of anything else or because the Attorney-General frightened it into thinking that it might be liable, if a patient used a specified purpose drug which caused some side effects, to be sued; so the Department of Health put ‘SP’ on certain drugs as a method of getting out of its legal obligation because the doctor will have realised that it is an SP drug and therefore the blame will fall on him. I do not think that argument would hold legally.
I forget for how many years - about 10 years - tetracyclines have been SP drugs. Doctors are not allowed to prescribe them unless for a specified purpose. Suddenly in the last issue of the list of drugs the SP has gone. Is there a reason for that?
– What does the ‘SP’ stand for?
– I know that ‘SP’ sometimes means starting price. The honourable senator has raised that point before. Why has it gone from the list? Why suddenly is tetracycline safe for doctors to prescribe for any disease whereas before we had to prescribe it only for a specified purpose? I mention cortisone also. Up till this last quarter a patient could not get cortisone unless he had a special authority. One would think that if the Committee changed its mind about cortisone it would include it with the specified purpose drugs, but the Committee has made it a general benefit, lt is free now for everyone. Doctors can prescribe it for any disease. At one stage they had to write and get a permit to prescribe it.
Previously 1 have mentioned the stupidity of thinking in relation to barbiturates. The Government wishes to stop drug addiction in Australia by not letting people have more than 25 barbiturates - sleeping tablets - at night. Who needs them? Once again the Government has forgotten the pensioner. The old person needs barbiturates more than anyone. Previously doctors could prescribe 100. Now they can prescribe only 25. Instead of the pensioner coming up for his 3 months supply of sleeping tablets - I a night - he now has to come up 4 times, for which the Commonwealth pays the doctor 4 times and the chemist 4 times, to stop the poor pensioner becoming a drug addict at the age of 70 or 80. Anything can happen. This is the stupidity that doctors have to put up with. The Government does nothing about it. It knows about it. It has been told about it. But it does nothing about it. The Committee will allow doctors to prescribe 50 milligramme capsules of nembutal. Doctors can prescribe 100 of those. If the doctor tells the patient to take 2 of those a night he can get over the Commonwealth’s restrictions to a certain extent because the doctor will be able to prescribe enough capsules for 50 nights. 1 refer to the psychotrophic drugs, which doctors are not allowed to prescribe. A general practitioner does not know anything about his patient! He cannot know what he ought to order. There are so many of these new tranquillisers and anti-depressant drugs now and the general practitioner is hopeless! Who knows best? The Department. Psychiatrists are not allowed to prescribe those drugs in private. They have to prescribe them in hospitals. The patient has to go back to the hospital every 3 months to get another certificate to say that he is entitled to have more of these and then the doctor can prescribe them. Who is to decide the fate of the patient - the Department of Health or the doctor treating him?
Recently I spoke about Intal. The Government shows the most ludicrous, the most stupid and the most callous disregard for patients by making doctors fill in a 4 page document so that they can prescribe that drug to treat asthma. It is put on the pharmaceutical benefits list as a specified purpose drug. It v/ould have been just as simple to say that it should be used for a specified purpose. But no. I have mentioned a case in which a general practitioner sent a patient to a specialist to ascertain whether the patient should be on Intal. The specialist, who is one of the top ranking specialists in Australia, said: ‘Yes’. He wrote - I will not say to where - to the capital city. Doctors have to write to the capital city and ask the Commonwealth Health Officer in that city. Who is this Commonwealth Health Officer? Where does he come from? What special knowledge has he? Where did he graduate and how did he get this special knowledge sitting there doing vaccinations and other duties? He knows best! He knows more about that patient whom he has not seen! He knows that the patient should not have the drug so he says that the doctor cannot prescribe it for the patient. Can honourable senators imagine anything more stupid or more callous? Any honourable senator who had a member of the family affected would be up in arms and would say that this system is nonsense. It is ridiculous and nonsense that the Department of Health can do it. Does the Department do it because of cost? It is not cost because, as I have pointed out, it costs $9.50 for 50 spinecaps whereas there are dearer drugs for hypertension and for other illnesses as well. These bureaucratic people have risen to the height of their incompetence. They do not know what else to do so they try to make everyone else incompetent so that they cannot deal with anything. Who should deal with the patient? The doctor should. AH honourable senators would agree with that. The Government says that there is indiscriminate use of drugs.
– Not all of us would agree with you.
– You would trust your doctor, would you not? If he said that you needed Intal would not you accept that?
– I am not talking about that. I am talking about overprescription. A lot of overprescription goes on.
– I am not talking about overprescription. I am talking about the necessity to use the drug. Overprescription occurs in any field, but doctors do not have to write to the Commonwealth for general benefits prescriptions. So why do they have to write for Intal for an 18 year old? Why do doctors have to put an adult on cortico-steroid - until he has had 7.5 milligrammes a day - before they are allowed to prescribe Intal when probably Intal would have stopped him prescribing cortico-steroid? How does the Government get out of this? It says that the Advisory Committee suggested it. How do we know the Advisory Committee suggested it? Whom can we trust?
– The Government has a Drug Evaluation Committee.
– That is for a different purpose. I refer to the Pharmaceutical Advisory Committee. The Government has lots of little bodies such as the Therapeutic Substances Committee which kills half the people. Today another drug has been discovered which has been described as the greatest breakthrough since penicillin. Where is it? It is called bactrin It is made by drug companies. One cannot obtain it unless one is a patient in a public hospital. If one is in a private hospital one cannot get it. This drug has been tested. An honourable senator mentioned the evaluation of therapeutic substances. This is another aspect which is so ridiculous. Bactrin has been tested in the United Kingdom and the United States. It has been passed by the people in those countries. But it has not been passed in Australia. Australia has set up its own therapeutic substance branch and it will deny this drug. Today one cannot have that drug. It has to go through the hospitals first. Yet my daughter in London is allowed to take it. lt is good enough for her but it is not good enough for Australians. This drug has to go through our bureaucratic system.
– What about thalidomide? That was one where caution was warranted.
– That is quite true. Caution is necessary. But if you had displayed the same caution with penicillin and bad not taken a risk one million or two million people in this world would have died. It is possible to drop dead from an injection of penicillin. But doctors still prescribe it. Thalidomide was an accident which everyone regrets, but the point is if you are going to hamper everything by this attitude you will never advance in medicine. This is a fact of life. But the Government has tightened up. There is a drug evaluation committee. The drug bactrin has been passed by the Drug Evaluation Com,mittee in the United Kingdom and in the United States. But this is not good enough for us. All right, let the Committee have a look at it. Why not give a tentative licence?
– What is it a specific for?
– It is for infection. Most physicians say that it is the biggest breakthrough since penicillin.
– Did you not say you could get it in hospital?
– Yes, if you become a patient in a public hospital you can get it.
– Are they using it here?
– Yes, of course they are using it here. But doctors in private practice are not allowed to use it. We are disturbed by the Department which seems to think that general practitioners know nothing. It is only the health officers employed by the Government who know anything. I deeply resent this attitude.
– If it is only given in a hospital, would it be because there is constant supervision of the case?
– And who orders it in the hospital?
– No, but-
– Yes, all right, one could say that. Just recently someone said that when be was a resident medical officer he could order any dangerous drug he liked, but now that he has reached maturity and he has experience he has to wait on the Commonwealth Department of Health to say which drugs he can use. In a hospital this drug bactrin can be used by the resident medical officer who has had no experience when compared with a general practitioner who has been in practice for some time. It is not good denigrating the general practitioner.
– Would the patient need watching after he has been given the drug in hospital?
– No, he would not.
– If the patient was away from hospital care would the ingestion of alcohol after the drug have any effect?
– No. A lot of these drugs are put on the list to be used in hospitals only, and then 6 months later or 3 months later they are taken off and provided for the next category such as ‘special authority’ or ‘specified purpose’. It is only a safeguard. A lot of drugs that are provided at the moment as tranquillisers do have adverse affects if accompanied by or followed with alcohol. But doctors are allowed to prescribe them. We are allowed to prescribe them if they are for a pensioner. This is what annoys us. Doctors are not allowed to order tranquillisers for a human being in Australia unless that person happens to be a pensioner. When he becomes a pensioner something radical happens to his body and we doctors have the free right to order for him whatever we like. This is stupidity which cannot be overcome. Why when one becomes a pensioner he is immune to the disgusting tactics of the general practitioner, I do not know. The Department goes to the extremes with bowel mixtures. If an ordinary human being wants to evacuate his bowels he has to take his medicine in a nasty form, but a pensioner is allowed to take an emulsion.
– Perhaps he has become a liability and we are not so much concerned with him then?
– This is what I suggested at the meeting of the International Pharmacy Guild when 1 spoke there. I suggested that perhaps the Government was trying to get rid of its liabilities to pensioners. We are allowed to give pensioners aspirin. We are allowed to give them practically anything we like.
– We can trust the general practitioner with this.
– We doctors are helping the Government. I just wanted to point those things out to honourable senators. We have to rush this complex Bill through tonight. We must be in Committee tonight. 1 understand there will be only five or six speakers. Now that I have prodded honourable senators we may have a few more speakers. But the suggestion is that this Bill is not important - let us not debate it because we do not understand it. The Government has said: ‘We want the legislation. We must put it through.’ So we will put it through. All I ask is that honourable senators support the amendment. lt may be difficult because the Australian Labor Party has a proposed amendment which is eliminated by the Democratic Labor Party’s amendment. 1 would suggest that when we do go into Committee, if this amendment is defeated we should ask leave to report progress because I think it should be known by now that there is complete disagreement between the establishment of the Australian Medical Association and all 3 general practitioner groups. There is no doubt about that. Four notices of no confidence have been passed in the AMA in 4 different States. One was nearly passed in my State of Tasmania. I asked the general practitioners not to pass it because 1 do not think it does doctors any good, and we defeated it in Tasmania. But there is a division within the AMA. There is no doubt that the AMA is going to have a terrible setback on 1st and 2nd June. There is no doubt at all that the 3 general practitioner groups have combined; that is, the Royal Australian College of General Practitioners, the General Practitioners Society in Australia and the general practitioners section of the AMA. These groups disagree with the AMA. Honourable senators can see how bitter the feeling is between the general practitioners and the AMA.
– General practitioners now have unanimity?
– Yes, they have. I think I can say that in every State we have agreed what should be done. We are not doing anything which will hurt the public. We have given a better deal to the public. That is why I ask honourable senators to wait. At some time or another I would like honourable senators to support the DLP amendment. If they cannot do this I ask them to support an amendment which will be moved in Committee. 1 ask honourable senators to do this because, for the first time, there will be a real assembly of the Australian Medical Association. Each delegate to the assembly has been authorised by his own branch. They had never been authorised on these subjects before, lt will be interesting to know what happens at this assembly.
– How many delegates will there be from each branch?
– It varies depending on the numbers from each State.
– How many will there be all told?
– I do not know. Like all general practitioners I do not take much interest.
– There will be about 80 delegates altogether.
– The trouble has always been that the general practitioner works at nights when the meetings are held. He never gets to them. I know it is his own fault. Nevertheless, it is a serious fault. He does not get to the meetings because he has to go out at night. He has evening surgery.
– This is true of every unionist in the country today.
– Yes, it is true. The general practitioner never gets to these meetings.
– Why did they not do all this in the pause they had when the legislation was before the other place.
– If the honourable senator could understand the Bill and especially the clause which I read out she would understand the length of time it is going to take to do this. It is a very complex matter trying to get unanimity between all States because of distance and so on. There have been telephone conversations in an attempt to get things done. I admit it should have been done more quickly but agreement has now been reached. I have always said that if a national health scheme is to work there must be co-operation between the government and the doctors. It is no use being at loggerheads. It would much rather see a scheme acceptable to general practitioners and the government.
Time and time again doctors have asked for the provision concerning ophthalmologists to be altered. Can honourable senators understand it? If I refer a patient to an eye specialist at any time and, in the course of looking at the patient’s eyes the specialist finds glaucoma or diabetes, or anything else, and he says the patient will be better off wilh glasses, the moment the glasses are prescribed the patient is precluded from the benefit. If the specialist had not prescribed the glasses the patient would have obtained the benefit. It is part of his duty to test eyes for refraction as well. We asked the Government to do this thing but it keeps on fighting because there is another pressure group saying that it does not want it.
– If the proposal of the general practitioners is accepted would not the patient have to pay more than $5 for certain services when he went to a specialist?
– Is the honourable senator talking about the ophthalmological one?
– No, generally.
– No, we are not arguing about the $5 one. They still have that. We are not arguing about that at all. I think the honourable senator will find that the general practitioners are not arguing in regard to that. I do not think there is anything in it that will be of any harm to the patients. We would like to see, or at least I would like to see - put it that way, because I am not on any of those committees although 1 am a member of all those societies - co-operation between the Government and doctors. If that is done we will get a better health scheme. It is much better to have a scheme whereby everyone is working together and then we can change it. If anyone can show anything that the doctors have suggested that will be harmful to the patients I will oppose it.
– The fees charged.
– I quite agree. I cannot very well oppose that. I am sorry; the honourable senator got me on the one that 1 cannot oppose. Nevertheless, this is what we ask and I ask honourable senators to consider seriously waiting till after the assembly.
– There has been such a period from when this Bill was first proposed to the present time and there is still not unanimity between the various sections. How much longer do we have to wait?
– They did have a meeting at which the delegates had been instructed earlier but, you see, the matter has to go to a branch and it has to go to a division. It is a very slow process by the time it gets to the top and then when it gets to the top it is a bit too late. But they have now agreed. I am not saying that the doctors are not in the wrong. They should have been united right from the start. But they have now got together at last and they have some agreement and they think they can make a better health plan of it. We think that there should be an amendment.
– Do you not think it is the hip pocket nerve that has been struck?
– Whose pocket?
– You know what the hip pocket nerve is.
– The general practitioner is not going to be worse off either way.
– You said that the medical profession now has agreed. Do you really mean that it has agreed to try to agree or do you feel that it is in an area of agreement?
– No, I think the fact is that all the general practitioner groups have agreed now. There are only specialists and so on. That is a different argument. But 1 think honourable senators will find that this meeting will produce a result. That is why I think we should wait until after this meeting. We should agree to this ophthalmological proposal by putting a clause into the Bill. Also, it is time we put a clause into this Bill to make it compulsory for the Minister to publish the names of the members of the Pharmaceutical Benefits Advisory Committee. He can publish them today but he will not. I think it should be made compulsory by a clause in the Bill to give a reason for the refusal to place a drug on the pharmaceutical benefits list. I am not saying why. The reason given as to why these people should remain anonymous is that these well known people who are leading lights in the profession are subject to pressure. I cannot mention any names, but 1 am sure that the 2 whom I know of would be a bit horrified to think that any drug company could apply pressure to them. But this is the Minister’s argument and it is time we got out of all this. So I ask honourable senators to support the amendment moved by the Democratic Labor Party. Later on, if that is defeated, I will move another amendment during the Committee stage.
Senator MARRIOTT (Tasmania) [5.59.1 - I just want to set the record straight before the suspension of the sitting. Senator Turnbull referred to the Minister for Health (Dr Forbes) - I know he meant it in a larrikin way but it is in the record - as a doctor of divinity. That is, of course, not right, and if there had been any decency at all that would have been corrected by the honourable senator at the time when he made his supposedly funny reference to the Minister. I had expected to follow a speech that would be of great interest to the Senate and of value to this debate because Senator Turnbull, is. I understand, a doctor. I know that he has been a Treasurer in Tasmania, I know that he has been a Minister for Health and I know he has been a self appointed specialist to the Royal Hobart Hospital, and we have heard a lot about medicine and health from him from time to time.
Sirring suspended from 6 to 8 p.m.
– This afternoon the Senate began a debate on a Bill for an Act to amend the National Health Act 1953-1969. Remembering that this Government came into power in 1949, this is at least the third legislative review of the national health scheme introduced by this Government. This afternoon we listened to Senator Turnbull who was supposedly speaking to the Bill, but he spent most of his time referring to certain drugs and the way in which drugs were allowed or were not allowed to be provided for various purposes. He then. 1 felt, cast a slur on his own profession.
I do not know what members of his profession have ever done to the honourable senator to sour his mind against them, but he informed the Senate that under the provisions of this legislation medical benefits would be available in respect of certain operations, some of which he named, including a face lift. He ridiculed that such operations should attract Commonwealth and fund benefits. This is a matter that one would deal with only lightly because, in my view, the medical profession would not abuse the trust that the people and the Government have in it. Its members would not take advantage of any such provision and operate unnecessarily or encourage such operations. So 1 pass from his tirade in which the only trick of oratory which I noticed was one which has been attributed to a great Russian statesman who would note on the side of his speeches ‘roar’ or talk loudly; this is a weak point’. Several times during Senator Turnbull’s speech his voice was raised very greatly and we who were listening realised that he was on weak ground in his criticism of the Government.
When we in the national Parliament come to debate this legislation we are dealing with a problem that has 2 basic important facets: Firstly, it is surely aimed at the physical welfare and wellbeing of the ill; secondly, it must be remembered that the national health scheme, the pharmaceutical benefits scheme and other social welfare legislation ure important parts of the fiscal policy and responsibility of any government. My colleague from Tasmania, Senator Lillico, earlier in the debate spelt out to us the annual costs of this scheme prior to the introduction of this legislation. All I want to say is that this legislation will add at least $29. 5m a year to this aspect of the national health scheme. So it is an important step forward in providing financial help from the common purse. In using the words ‘common purse’ I emphasise, unlike Senator Turnbull who said that the Government would not give people this or that in the way of financial help, that no money that the Government gives belongs to the Government - it is money which is on loan from the people of Australia. So when a government makes financial benefits available to the people it is not giving them something for nothing; it is taking from all and sundry to give back in varying degrees to varying types of people in varying types of need.
Surely the aim of a national health scheme - at least one put forward by this Government - is to provide the highest quality medical services to all who are in need of those services and to provide them at a cost which is, as nearly as possible, within easy reach of all the people in all circumstances of life. At the same time as it is providing those services it must have a scheme under which the medical profession receives a fair return for professional skills, for the training that members of the profession have undergone and the study they have undertaken to keep themselves abreast of modern times. They must receive not only a fair return but also an incentive for them to carry on their great work of ministering to the sick at all hours of the day and night under all conditions. It must be borne in mind that in providing for the people the financial set-up must be such that the medical profession in all its various facets must receive a fair return.
I come now to the actual reason for the introduction of this legislation. In the policy speech of our Prime Minister, Mr John Gorton, during the last election campaign for the House of Representatives it was announced that there would be a new approach towards widening and improving the national health scheme. The announcement came almost as an earthquake among members of the medical profession. I understand that many representations have been made to all members of the national Parliament. This is right and this is understandable. In addition we have received written representations. We have had deputations, telephone calls and visits, from all of which I at least have come to understand for the first time that the medical profession is to some extent in a form of disarray. This is highlighted by the varying representations from various sectors of the medical profession who have come to win over members of the national Parliament.
I should think that prior to this period the average Australian awed and revered the medical profession, in which he included the general practitioner, the family doctor - that great help at all times, the real guide, philosopher and friend - and then the specialist to whom one was referred if the general practitioner felt that professional specialist advice and action was required. But now we realise that there are quite a number of sections of the medical fraternity who are working on and among members of Parliament on their own sectional behalf and not on behalf of the profession as a whole. Just briefly I mention the Royal Australian College of General Practitioners, the section of general practice, the Australian Medical Association, the Royal College of Physicians and the Australian Medical Association of New South Wales which are some of the many sections of the medical profession which have been making representations to us and submitting claims presenting their particular outlook in relation to their particular rights that they feel are being hampered or trodden on by this new legislation. We have learned from Senator Turnbull that they have realised that they must now get together to try to form a united front.
The Australian Democratic Labor Patty has moved an amendment to the motion for the second reading of the Bill. The amendment suggests that this measure be delayed to allow the medical profession to meet as a profession to try to iron out its own difficulties and then to return to the Government with a united case for amendments to or deletions from the legislation now before the Senate. In my own mind I cannot agree to the proposed amendment. I hope that it will not even be pressed. It may sound very fair to the medical profession that this Parliament, having so many types of suggestions for amendments made to it, should wait and consider them and weigh the united front of the medical profession, but I wish to state my view. It has been announced that the Government intends that this legislation should become operative by 1st June. Whether one likes all this legislation or only part of it, it cannot be denied that once it becomes law many people on all standards of income and of living when requiring medical attention will start to receive greater financial benefits to help to pay the costs associated with their illnesses. Therefore I do not think it would be correct for the national Parliament to stop legislation that in the whole is aimed at all Australians, and in particular amendments is aimed at 284,000 people in the community.
This legislation should not be delayed while the medical profession puts its house in order and becomes a united force - as 1 for one thought it was before October last year - and finally returns to this Parliament with suggestions for amendments. Of course, we would not be able to deal with those suggestions until the Budget session and so there would be a delay of some months before the real benefit that can flow from this legislation would go to the people. My outlook on the matter is that it is obvious that we will not have a satisfied medical profession the moment that this legislation becomes law, but I believe that its members will reach a unanimous decision earlier as to the amendments they want when they see this legislation in operation. 1 believe that they will learn more rapidly, they will come to a united decision more quickly, but in the meantime the good that can flow from this legislation will be flowing from the Parliament to the people who need it to help to pay their medical bills.
I do nol like to hurry legislation, but when good can flow from it to the people I. think if possible we should get that legislation into operation. I believe 1 am truthfully reporting the Minister for Health (Dr Forbes) in staring that he said that if amendments are required and a case is put to the Government and to him, amendments will be introduced to try to satisfy the persons who are disgruntled wilh the legislation. I do not believe that it is right, for the medical profession to expect the Government or individual members of Parliament to act on all the individual sectional representations that have been made to us. I remind honourable senators of the procedure with repatriation legislation. The Government listens to representations by the Returned Services League, the spokesman for all ex-service organisations; the Australian Council of Trade Unions for the trade union movement; the Associated Chambers of Commerce for the business people; and the Associated Chambers of Manufactures for the manufacturing interests. These big organisations should have the goodwill and the discipline amongst themselves to present a united case to the Government. Our Government has always shown that when a united case is put to it on behalf of a section of the community - whether it is an important, powerful section or otherwise - it will listen to that case. 1 now turn to deal with certain aspects of the legislation which have induced me to support it. At first sight the Bill seems to be a massive document, but in reality it has only 55 clauses. There are 7 schedules which set out important details in putting the legislation into effective use. I suppose it is true to say that the main point of the legislation is that for the first time it decides on a common fee that will be charged and makes provision that fund and Commonwealth benefits combined will result in a patient’s having to pay never more than $5 for a single medical treatment. The many medical benefits funds - and although there are many of them in Australia 1 will not be sidetracked into discussing whether there should be fewer or more funds - must be giving satisfaction, otherwise people would be leaving the smaller organisations and changing to the funds that are giving satisfaction. The funds charge different premiums to their subscribers in different States. In respect of the common fee this legislation makes provision for variations from State to State. The benefits that are to come from the medical funds - the actual dollars and cents - vary from Slate to State according to conditions under which the subscribers have taken out medical benefits policies.
Schedule No. I is the important schedule for the average recipient of benefits, and also for the medical profession, it sets out the rales of Commonwealth benefit. The Minister’s second reading speech states that 340 medical services are included for general practitioners and/or specialists. I he patients will receive the benefits of the higher refunds for specialist services if they are referred by a general practitioner to a specialist practising that speciality. In my view one of the weaknesses of the national health scheme has arisen - not from a legislative point of view, but from the viewpoint of the medical profession - when the old trad tion has not been followed of the family doctor referring a patient, if he thought fit, to a specialist. Even under the present scheme the return is greater to a patient who is referred to a specialist. If the patient goes direct to the specialist the fund benefit is much smaller than it is if he is referred to the specialist. I believe thai this is where the medical profession has gone astray. It has not kept to what I think we all believed was the tradition, namely, that the specialist did not see a patient direct from the street; the specialist saw only a patient who was referred to him by a general practitioner.
This Bill sets out the machinery by which specialists will be registered and accepted as specialists under the legislation, although the Minister pointed out in the second reading speech that the actual registration of specialists in the Australian community is the responsibility of the States. I have referred to the provision in the Bill to the effect that the greatest cost to a patient for a medical service will be $5.
I believe that in my State of Tasmania particular problems face members of the medical profession. I cannot speak about the situation in the other States because 1 have no direct information on it. But it is my belief that members of the medical profession in Tasmania - both general practitioners and specialists - kept their fees down so that when the patient received his bill he received by way of refund, in the medical benefits fund payment and the Commonwealth benefit, a fairly large percentage of the doctor’s bill. I know of many doctors in Tasmania who, when people are in financial distress, are quite happy to receive only the cheque that comes from the benefits fund, including the Commonwealth benefit, and to go without the extra charge that they can make quite legally.
But, if the Commonwealth pegs the fees of Tasmanian doctors; - both general practitioners and specialists - at those operating How, when (he doctors have kept their fees down in fairness to the community and in an effort to make the national health scheme work, it will create a financial problem as far as the income of general practitioners and specialists in Tasmania is concerned and in the years ahead we will have the problem that there will not be the enticement for specialists in particular to come to Tasmania because under this system their fees will be pegged if. they keep within the common fees. I have set out the problem, but I am prepared - I believe that the general run of practitioners in Tasmania will agree with me - to get this legislation into operation and then, on the basis of /acts, to put a case to the Minister for
Health and the Government as to what weaknesses have been shown up and what jj needed to ensure that the medical profession receives a fair deal and that there is an income incentive for doctors to specialise and to come to a State such as Tasmania where, of course, we will need some specialists in all branches of medicine.
I do not propose to say much more at this stage. I believe that there will be debate on certain aspects in Committee. I cannot agree with the amendment moved by the official Opposition - the Australian Labor Party. It really means nothing. It is just a recitation of words, spelling out that Party’s Socialist policy but making no effort to put that policy into operation. Therefore, it is not worthy of further comment. Although I believe that the amendment moved by the Australian Democratic Labor Party is one that could bring action, I plead with members of that Party not to force the issue. Let us get the legislation into operation. Members of the medical profession have been awakened to their responsibilities to get together and to put a combined and united case to the Government on any anomalies that may be proved to exist in this amended national health scheme.
I do not believe that the Government can in any way be complained about for slow action in respect of this legislation. As I pointed out in my opening remarks, the original legislation was introduced in 1953 and this is the third time the Parliament has been called upon to look at it. I believe that in the long run this scheme will prove of great value to the greater number of people in Australia. Let us remember that there are other people who are already covered by the pensioner medical service and a very large number of people who are covered by our repatriation services. I support the Bill.
Senator TURNBULL (Tasmania) - I wish to make a personal explanation. Senator Marriott stated just before the dinner suspension that I had appointed myself to the position of a specialist at the Royal Hobart Hospital. The facts of the matter are as follows: It is true that at the time in question I had just become Minister for Health in Tasmania. I had been an honorary dermatologist at the Launceston General Hospital for more than 3 years, if not 4 years. I then moved to Hobart, and a part time officer of the Department of Health, who had taken on the job of honorary dermatologist at the Royal Hobart Hospital as 8 fill in job, resigned his position. The Board of the Hospital then appointed me. I myself had nothing whatever to do with the appointment.
– Just before the sitting was suspended for dinner, Senator Turnbull was speaking. He deplored the paucity of speakers and said that he thought some speakers would be drummed up. f want to assure the Senate that I was not drummed up. lt is on historical record, in the form of the piece of paper in front of the President or other honourable senator occupying the chair, that my name preceded that of Senator Turnbull. But. with the decency that is so characteristic of me and with my usual modesty and humility. 1 permitted him to precede me. I deplore with him the paucity of speakers, but that is just one error that 1 wanted to correct.
I knew that he would almost certainly ventilate his spleen, on occasions amounting almost to haired, against the officials of the Department of Health. I disagree with him on this point because I believe that the officials of the Department of Health are extraordinarily capable men and I appreciate their sincerity of approach. Perhaps Senator Turnbull, in his tolerance, might sometimes think that they are the servants of a parsimonious government and that, when there are restrictions on the prescribing of pharmaceutical benefits, economy might dictate their actions. 1 agree with him on the difficulties experienced by practitioners in relation to certain drugs being put on and taken off the list by the Pharmaceutical Benefits Advisory Committee. But I appreciate the position of the members of that Committee and their desire to remain anonymous, because any reasonable person can realise the pressure under which they would labour if their names were known to all the drug firms. The view that would be taken by the drug firms would be that with a little more pressure they would have their products on the pharmaceutical benefits list. 1 believe that the Government might well give consideration to the idea of sending out to practitioners a short note giving the reason why a drug is taken off the list, particularly when a drug is taken off the list and the members of the Committee realise, as they must realise, that the average practitioner thinks that that drug is of value to his individual patients. Perhaps the Government does not want to make it known to the public that this is an economic measure rather than the result of a medical approach.
In relation to the Bill, Senator Marriott mentioned that this was the third series of amendments to this legislation. I sympathise with the Prime Minister (Mr Gorton). He is attempting to erect a monumental edifice on weak and unsatisfactory foundations. I suppose that no Prime Minister in his tenure of office has been more the victim of vituperation than has the present Prime Minister. He has been subjected constantly to biased attacks by newsmen through all propaganda media, the Press, radio and television. But by and large the greater number of them are not content to, or will not, or know not how to, report news objectively. They have to report it authoritatively, posing authorities in fields in which, by and large, they have no expert knowledge. His public relations officers have failed him. The Prime Minister also is subjected to attacks by disloyal party colleagues who seem to leak slanted information to pressmen of their own choice and suggest that the Prime Minister does- not know the basic Liberal philosophy. I frankly do not know the basic Liberal philosophy because I do not think that the Liberal Party has had any since it was founded in 1945. By and large, if there is a popular idea in Labor’s programme, the Liberal Party will borrow it. If there is a straw of popular appeal blowing in the electoral breeze, the Liberal Party will adopt it and bring it into legislation.
The Prime Minister also is, we might say, the object of supplication by and large by money grasping, snivelling Premiers who, whenever a financial difficulty faces them, cry for more money from the Federal Parliament. Never are they prepared to face the odium of introducing taxes or of increasing them in the fields of taxation which are available to them. The first responsibility of a government is to tax if it wants to do something and it is convinced of the real nature of the justification for it. But the State Premiers are not prepared to do this. T am not saying that there is not justification for a reorientation of thinking regarding State and Commonwealth financial relations. That is not my approach at all. f think there is justification for such reorientation of thinking. But I realise, and I think every other honourable senator in this chamber realises, that State Premiers by :ind large are not- prepared to face up to the odium of increasing taxation or of introducing new taxation.
Turning to the Bill under discussion, practically the whole of the debate in the other place and in this place has centred on the medical aspect. I think it is a much bigger issue than that, and I propose to make my basic fundamental thoughts available to honourable senators for what they are worth. I would not make them available unless I thought that they were really worth while. First and foremost 1 think the medical profession must realise that it has a responsibility to determine a basic philosophy of medical practice. Sometimes I think we are wrong in our approach. What do we do today? 1 do not espouse euthanasia at all, and I want to make that quite clear, but sometimes I think we are tempted to try to keep alive people who are prepared to die and who realise the inevitability of death. We are prepared to spend thousands of dollars keeping an old person alive, but we are not prepared to devote a similar amount of money to the care of the young when their condition is something that can be treated or their disability is capable of rectification. I think that the medical profession has to face up to this responsibility because the costs of medical, hospital and ancillary services are increasing at a tremendous rate. It has been suggested that hospital costs are increasing at the rate of 10% per annum.
I support the amendment which has been moved by Senator McClelland. It is not entirely my full wish in relation to medical practice. This is not an alternative medical scheme. I want to make it quite clear to honourable senators present in the chamber that it is an alternative method of financing the present unsatisfactory scheme. I think that health is a fundamental, basic human right of people. Not only is it a basic human right, but it can make a contribution to the economic welfare of the nation, because a healthy community can produce greater economic productivity in the welfare of the country. I think that the nation has a responsibility to face up to its total responsibility for health in the same way as it has attempted to do for education. For many years we have been crying out about the basic educational needs of the people and their children. 1 believe we have to face up to the responsibility of meeting the medical, hospital and ancillary service needs of the people. These are basic needs. We are not doing anything about them. We are facing up, in part, to the medical needs of the people, and the Government, by adopting a comparatively parsimonious approach, has faced up to some measure to the hospital needs of the people. But we do not face up to their total real requirements.
Ever since I came to the Senate 12 years ago I have been suggesting that the voluntary health insurance scheme was in need of inquiry, that there were many anomalies in it which required rectification, but I was not instrumental in persuading the Government to do anything until the present Prime Minister ascended to power. What did he do? He appointed an ad hoc committee - the so called Nimmo Committee - with a specific purpose. It had to make findings within the ambit of the present voluntary health insurance scheme, lt was not given authority to go outside the ambit of the present scheme. Certainly the Senate Select Committee on Medical and Hospital Costs could and did go outside the ambit of the voluntary health insurance scheme and it made many worth while suggestions - much beyond the suggestions of the Nimmo Committee - but the Government and the Minister for Health (Dr Forbes) saw fit to take no notice of the suggestions. In the process of time I will, in my limited way, try to point out what I think are the weaknesses of the present scheme in catering for the real and legitimate needs of the people.
In this Bill there is no provision for dental care. Everyone knows of the requirements of children, in particular. Dental care will become a decreasing burden as the furtherance of the process of fluoridation takes place. This is in accordance with all the suggestions of dental scientists, dental hospitals, dental research units and so on. But there is no suggestion of any alleviation of the burden of costs of parents who today will tell you of the burdensome financial requirements in providing dental care and treatment for their children’s teeth.
For years I have suggested - so much so that I have got tired of suggesting it over the last 2 years - that a differential approach should be adopted to the payment of fees as between specialists and general practitioners. I would be the last one to decry the role played by genera! practitioners in the medical service. I realise that because of the length of time which general practitioners spend at universities and the time which they serve in hospitals before they enter general practice, they are entitled to reasonable remuneration. But no-one can deny that today and over recent years they have received reasonable financial remuneration. In fact, the voluntary health insurance scheme inaugurated by the late Sir Earle Page has proved to be a bonanza for general practitioners. The scheme was founded on the basis of service provided by general practitioners. I do not agree with the grizzling, carping attitude adopted by general practitioners today. They gave me a list of, 1 think. 341 items in which there is a measure of conflict as between the rights of general practitioners and of specialists. As 1 perused the items, many of the procedures can be performed equally well by general practitioners and perhaps the)’ may have a case for receiving higher remuneration. But it is for them to argue that they should receive a higher remuneration for the particular items. By and large, it has been accepted practice ever since I can remember that for particular jobs specialists should receive a higher remuneration than general practitioners, and the people have been prepared to pay it. I think that the Government has been wrong here in adopting this $5 approach, if it had adopted the approach of paying 90% of the common fee for specialists and 90% of the common fee for general practitioners, there would have been no trouble, I think, with general practitioners. That suggestion was made by the Senate Select Committee.
A register of specialists has existed in Queensland for 30 years, and one has existed for a number of years in South Australia. Mr Jago, the Minister for Health in New South Wales, is now proposing - and the Australian Medical Association has agreed to it - that a register of specialists should be established in New South Wales. I think it is inevitable. In the next few years I think that all States will determine a register of specialists, which is their own prerogative. The Commonwealth can determine a register of specialists in the Australian Capital Territory, in the Northern Territory and in all of its other Territories.
If not, I think that the Director-General of Health with advice from medical practitioners or the Australian Medical Association, whichever you wish, can determine a register to serve his own purposes. However 1 think he would be wise to accept the register as determined by the States because after ali it is within their powers to determine the role of medical practitioners within their own boundaries. it is interesting to note from a reading of the speech of the Minister for Health that there is little or, I think, no mention of the problems of hospital care. This is a field in which there are rapidly increasing costs. There is an increasing intricacy associated with medical service in hospitals, and associated with that are increasing financial burdens. It is the responsibility of the Government to face up to those burdens. In 1967-68, the last year for which details are available, hospital costs mounted to $366,215,000 while the cost of medical services in hospitals was $177,262,000. So the tremendous burden of hospital costs is apparent; and they will not become less. This is not the only hurden to be borne by the people. The Government seems to forget this and I think that we forget it in our amendment as well because we are proposing only au alternative method of financing the present unsatisfactory scheme.
I should like to see introduced - I think it is inevitable in the process of time and if I had the time I could justify it - a complete scheme embracing all health, hospital and ancillary services. Where is the provision for calipers? Where will be found the money for crutches, wheelchairs and so on for people in financial need? There arc so many deficiencies in this scheme that of itself it stands condemned. I know that it represents some measure of assistance, and we on this side of the House are anxious to provide all the assistance that a parsimonious government is prepared to give to the unfortunate people of this country.
It is time that we had a real inquiry into the legitimate needs of the health of the people. Canada is a country which most recently undertook a complete investigation of the health needs of the community. It embraced not only medical care but also the training of dentists, the training of nurses, the research requirements of the community, the remuneration of practitioners in the field of health and so on. But let us remember just what the position was which faced Canada and the time that was taken. The personnel of the royal commission embraced men of all callings who had a thorough knowledge of health and health needs. They spent 4 years on an inquiry. The Nimmo Committee spent 6 months; the Senate Select Committee on Medical and Hospital Costs spent less than 12 months. The royal commission in Canada had a permanent staff of 167 researchers engaged full time researching the health requirements of the community. Out of that came a worthwhile report. Whether the nation will be able to afford the scheme, I do not know. That will be Mr Trudeau’s worry when he returns home. Apparently he is finding it fairly hard to finance.
We have to find the limit of the burden that the community is prepared to bear in relation to increasing medical costs. Perhaps it might be beyond the capacity of the community to pay. I do not know, but there is a justification for giving the best and most worthwhile medical and hospital services to the people. This may be a temporising approach. Let us hope that the Prime Minister will realise that this is only one of the major errors, not of his making. He has inherited this legacy from his predecessors and in the near future he may seek to correct it and provide a full and worthwhile health service for the community embracing health, hospital and ancillary services. These are desirable; these are necessary; these can be provided. I know that they will cost a tremendous amount of money. Some few years ago when we took out the cost we found that it would cost something like Si, 155m to provide these services for the Australian community. I suppose that if we took out the cost today it would be over $ 1,300m. It is a question of what the community is prepared to find. Whether it would be by way of compulsory levy or by way of voluntary insurance is for the people to decide, but I think it is justifiable that we should be in possession of full information relating to the legitimate requirements of the community, It is up to the Government, as the controlling instrumentality in the
Federal Parliament of Australia, to see that these needs are met adequately, reasonably and in the best possible way.
Senator Dame Annabelle Rankin, who in this place represents the Minister for Health, may say that this is the Government’s idea of an adequate approach. So many have condemned it. The people have condemned it for years since its establishment. They have objected to the margin that they have had to find. That was not all that they had to find. The majority have had to find their contributions to the health funds as well as the margin varying between 29% and 35% to pay to the doctors. Consequently we must realise that in the final process it is the individual in the community who bears the burden of the financial cost of all the services. We have a responsibility to find the optimum way of providing these services for the people.
I know that many minor amendments will be moved. We all have been subjected to pressure. I think that ophthalmologists have a legitimate grievance. From the inception of the scheme they were not provided with a specialist differential fee as regards a visit if spectacles were prescribed. This has not represented the burden on individual patients that a lot of people would believe. I know many ophthalmologists regarded their treatment as involving 2 visits. They diagnosed the medical condition and treated it and regarded that as 1 visit. Then if spectacles were necessary a subsequent visit was involved for which the specialist did not charge, so the position was regularised and the patient did not suffer because the differential fee for a particular visit was paid. My personal opinion is that it should have been paid right from the inception of this scheme but there was pressure from the optometrists. If my scheme were adopted the optometrists would have their place in it and their fees would be provided for. That would be one of the ancillary services.
The Government says that the benefit funds, as they exist, can provide the ancillary services of their choice and within the limits permitted by their financial surpluses. This is a hit or miss scheme which does not meet the needs of the people. The extra requirements are endless but I mention only a few such as physiotherapy and optometry. I could name the whole lot of them.
There is no suggestion of meeting those in toto. I believe that the Government has a responsibility in this matter. I plead with the Minister to make submissions along these lines to the Minister for Health. This Bill is not an answer to the needs of the people. Honourable senators on the Government side have a responsibility to meet the legitimate medical and hospital needs and the ancillary services required by the people of Australia. It is a basic human right.
Honourable senators opposite are prepared to talk about education. What is more necessary than a healthy community; a community which can live happily enjoying good health; a community which can face up to economic burdens more efficiently: a community which can make a greater economic contribution to the welfare of the nation? But the Government is not prepared to do anything about that. As long as the Government has something which it thinks will hoodwink the people and give them the impression that they are getting something which will minimise their costs, it feels that it should not go any further. But in no way is the Government meeting the legitimate requirements of the people. I commend my views to the Government. It has neglected my views in the past but now as I am in the process of moving from this place I hope that in the process of time it will pay some tribute to them.
– The Senate is debating a Bill to amend the National Health Act. This will be the third occasion on which the Act has been amended in the last 3 years. I congratulate the Government on the provisions contained in this Bill; it is a very sizable piece of legislation. National health is a very contentious matter. The provisions of this Bill are the product of many years of study by the Government of the question of health in the Australian community. The Government appointed a committee of some note to investigate the matter and make recommendations to it. I refer to the Commonwealth Committee of Inquiry into Health Insurance, which is known as the Nimmo Committee. After much serious study of the matter the Government now plans to bring into effect the major recommendations of the Nimmo Committee. I believe that this legislation will eventually result in giving great financial protection to the Australian community against the cost of medical and hospital treatment.
The core of this legislation and the provision which the Prime Minister (Mr Gorton) said he intended to see brought into effect is the general provision that the Australian community can feel assured that when this legislation becomes law no medical treatment will cost a patient more than S5. I think we all support this principle. However I should point out that it may cost the Government $35m to make available the benefits provided in this legislation. This is quite a considerable amount of money. [Quorum formed.]
The main concern I have about this legislation is that there is a possibility of a drift of patients from country practices to the city. It would appear to me that under the proposed system of referral and the cost structure a patient will generally seek the services of a specialist. One can view the matter in this way: If it were possible in the legal field to obtain for an extra 80c the opinion of eminent Queen’s Counsel I think one would bypass one’s local solicitor and obtain the view of a specialist. This principle is inherent in the Bill before the Senate. It would appear from discussions 1 have had with some country general practitioners that there is a possibility that patients will bypass general practitioners for specialists. However the Government has provided that in actual fact the referral shall be by a general practitioner. The Minister for Housing (Senator Dame Annabelle Rankin), who represents the Minister for Health (Dr Forbes) in this chamber, said in her second reading speech:
The First Schedule in this Bill is different from the Schedule to the present Act in one important aspect, in that it provides for differential rates of Commonwealth benefits to be payable for 340 selected medical services depending on whether the service is rendered by a general practitioner or a specialist in the practice of his specialty. The fixing of differential benefits in this way will ensure that patients receive adequate rebates against the costs of medical treatment when the treatment provided includes the services of a specialist. The higher benefit rebates will be payable only where the services are provided by a specialist in the practice of his specialty and the patient has been referred to him by another medical practitioner-
I do not think that it is a very brilliant system, but undoubtedly it is a system which is designed to get over the problem of general practitioners receiving’ lower fees than specialists on occasions. If the Minister has spelt it out correctly in her second reading speech, and 1 take it she has done so, higher benefit rebates will be payable only where the patient has been referred to a specialist by another medical practitioner, in actual fact it means that in every case a patient must go to his general practitioner before he can go to a specialist, which seems to me to spell out 2 fees for the one service. It may prove to be in practice red tape procedure. 1 see a problem in this respect. I regret that it is necessary that it should be so. 1 ask the Minister to comment on this matter.
– Does the honourable senator accept that it should be so?
– 1 am bringing it to the attention of the Minister. In my opinion there is great wisdom in requiring a patient to go to his general practitioner before his referral to a specialist if he wishes to obtain the rebate which is to be provided on the specialist’s fee, but it means that 2 fees must be paid by the Commonwealth for the 1 ailment, which does not seem to me to be very wise. I think this particular point illustrates what could occur in country practices. I predict - it is quite impossible - that some subsidisation of practitioners in country areas may be necessary in the near future. I plead with the Government and the Minister to take on board the fact that we must walch very closely what is happening in the country areas because there is a view abroad that this Bill may spell a decline in the number of general practitioners who will seek work in country districts. Indeed, it is very difficult to attract them to country areas in sufficient numbers at present.
One other point I wish to mention is in relation to the hospital and medical benefit funds themselves. Over the years I have not been enamoured of the fact that there have been enormous increases in the reserves which are held by some of these funds. I do not know whether the Government has done anything about the funds other than to suggest that they become more efficient in their administration. I imagine that the Government will have to make a decision somewhere along the line that only a percentage of the turnover of each fund must be held in reserve. I draw the Minister’s attention to that part of her second reading speech which refers to organisations in which membership is open to the public. I ask the Minister to comment on whether there is somewhat of a paradox in the comments which she has made regarding the operation of a fund in any State. 1 query whether the occasion will arise when an organisation is not approved within a State and, if so, how the comments the Minister has made in her second reading speech will then apply. The Minister said in her speech:
Open organisations . . will be required to establish and operate a separate fund in each State in which they are registered to carry on business and to maintain and- submit separate financial statements each year in respect of each fund.
I congratulate the Government on its attempt to bring some efficiency into the recording of transactions, which are to be brought before the Parliament. The Minister said:
This will enable the separate identification and assessment of the financial experience of the organisation’s operations in each State. Approval for an open fund to operate, in a particular State will not be continued unless it is shown that economic and efficient operations in thai State can be expected.
I put to the Minister that in one part the Minister is saying that they will be required to establish and in the next sentence the Minister is saying that they will not be allowed to continue unless. I suppose that they will be allowed to continue whether or not the conditions are fulfilled. 1 appears that funds will be required to continue and it will be only by soft persuasion, 1 imagine, and by the Department attempting to demonstrate some level of economic and efficient operation that can be expected from the fund, that this will be brought about. I see quite a difference in those 2 statements that the Minister has made - one, that the fund will be required to establish and, the other, that the fund will not be allowed to continue unless certain provisions of the regulations are adhered to.
I congratulate the Government on one other point. Surely all honourable senators will do so. The Government will receive hearty congratulations from every honourable senator for this. I refer to the Government’s decision that families on incomes which we, in this day and age, consider are not adequate for the proper sustenance of a family should receive their medical benefits entirely free. I think all honourable senators should give unanimous approval lo the Government’s decision that families with incomes of up to $42.50 per week will be entitled to full medical benefits and hospital benefits equal to the cost of public ward treatment without the payment of any contribution.
– Senator, would you agree-
– I congratulate the Government, as you are doing, Senator Milliner, for the excellent step that it has taken in this regard. This and other decisions by the Government will affect many less affluent families. The Minister stated: lt is estimated that some 84,000 families and 271,000 persons will be eligible for assistance. They will be eligible for the variety of assistance that is spelt out in this Bill. I think that there are some points of the Bill about which one could think that there is duplication, as I have mentioned and that there are possibilities of argument by the general practitioners who have been quite vocal and who appear to me to have a good case. There are the problems of the ophthalmologists. I agree with the contentions that they have put forward. I do not think that all the experts in this chamber, in another place and among the public in general - if they were to set about and attempt to design for the money that is available - could come up with a better medical health scheme than the one we will have. This has been built up over the years. The amendments to the Act will provide a better medical health scheme. I agree that the Government has done the very best that it could on the information and the expert evidence available to it. I congratulate the Government for bringing in this Bill.
– Senator Webster commenced his remarks bv congratulating the Government on implementing a major recommendation of the Commonwealth Committee of Inquiry into Health Insurance - ‘the Nimmo Committee.
– I finished that way, too.
– The honourable senator used the words ‘major recommendation’. We all have our own ideas of what the major recommendation is. To my mind, the major recommendation of the Nimmo Committee concerned the list of common fees. The medical profession were to be bound to inform their patients of the list of common fees and of the fee that they proposed to charge for the treatment. That is not to be found anywhere in the Bill. Those who charged in excess of the common fee would not be within the scheme. To me, this is the major recommendation of the Nimmo Committee. It is the very foundation of what I want to talk about tonight because the doctors have stated already that they will not adhere to the common fee formula. The cost of medical treatment to the patient will be much greater than $5. Advocates in favour of this legislation have been saying constantly that the patient will not be required to pay more than $5 whether he goes to a specialist or to a genera] practitioner. It is quite wrong for people to stand in this place as legislators and endeavour to mislead the public in this way. The $5 that the patients will be required to pay under this scheme will apply only if the medical profession operates on the list of common fees. Everyone here knows full well that many medical practitioners charge in excess of the list of common fees.
– Yes, but the patient has the power and the ability to find out from the practitioner what his fees are.
– The only power that the patient has to find out the common fee that is to be charged is the 4.5 million pamphlets that the Government will publish, using public funds and distribute throughout Australia in an effort to bolster its own scheme which has no foundation. The 4.5 million pamphlets which will be published with public money and which will have the postage on them paid by public money will go into every household so that the occupant can ascertain what the common fees are. The Government’s policy was stated quite clearly by Sir William Refshauge when he said that the Government would encourage but certainly not compel adherence to the list of common fees. That is the basic weakness in the scheme that the Government presents to Parliament for approval. That is only the start of the mess that this legislation proposes because the list of common fees is not only a list of common fees for medical practitioners, be they GPs or specialists, but also a list showing the common fees applicable in the 6 States. In some States the list of common fees is higher than it is in other Stales. This means that the charges of the medical practitioners in the States in which a lesser fee is charged than that charged in other States will attract a lesser benefit. This has its disadvantages, lt may be said that in some States the lower fees were justified because of the difference in the cost of living and in the cost of maintaining a practice and a family.
At this stage I speak only of my home State where over the years the common fees have been somewhat lower than the common fees in the eastern States. This was based mainly upon the lower cost of living in Western Australia, but the days of the lower cost of living in Western Australia have gone. The cost of living figures for that State are about the highest of any of the States. Under this legislation the medical practitioners practising in that State will be bound to a list of common’ fees which are below the common fees in the eastern States. Can the Government justify a national health scheme which provides different benefits - I emphasise the words national health scheme’ - according to (he residence of the Australian citizen? I say that the Government cannot justify such a scheme. At any lime the labourer is worthy of his hire. The ultimate result of having different sets of common fees in the different Stales must eventually be to erode all the medical services in the States with the lower common fees. It will inevitably mean that medical practitioners in the States where the lower fees are charged will endeavour to lift their fees. The difference between what a person pays and what he receives in benefits will increase beyond the $5 now provided A person will pay very much more for the medical service he receives.
If the fees are higher in one Slate than they are in another State, is it not obvious that the medical practitioners will tend to migrate to the State where the highest fees are paid? In this case that means New South Wales: All members of the medical profession will want 10 practise in New South Wales because they will be receiving a higher payment for the services they render. Not all of them will be successful. Only the best of them will be able to work up a sufficient practice to be able to carry on. We all know that in all professions and in all walks of life some people excel at their work and others do not. Those members of the medical profession who are unable 10 establish themselves in the States where the higher fees are paid will go back to the States where the lower fees are paid. What does this mean? With respect to the medical profession, I say it means that a second rate service will be provided in the Stales where lower fees are paid. It is inevitable that this will result from a scheme of this nature. 1 ask the Government whether it has made any preparation for adjustment of the fees. One of the problems which faced the medical profession in the original concept was that there was no provision for an adjustment periodically in the list of common fees in accordance with increases or decreases in the cost of living. I ask the Government whether there is any consideration given in the legislation to adjusting the common fees as between the States. In order that this second rate service - as I call it - will not be allowed to develop and operate in the States where lesser fees are paid some escalating clause should be inserted in the legislation to allow States which are presently able to operate on a lesser fee to bring their fees, as their costs increase, up to the fees which are charged in other States. I must repeat that doctors will tend to migrate to the places where they can obtain the greatest remuneration for their services. I am unable to contemplate a national scheme which provides benefits that differ on a geographical basis as to Australian citizens. When schemes of this nature are introduced the Australian people are divided. The Government, by the introduction of this scheme, has divided the medical profession. Today no-one has any faith in the Australian Medical Association except the specialists. Under this legislation the specialists just sit pretty and collect the fees as they come along. But the general practitioners will be endeavouring to hold their patients rather than send them to specialists for treatment. The patients will want to go to specialists for treatment
I ask the Government: What is in the best interests of the patient? What is in the best interests of the medical profession? If the patient wants to go to a specialist and the general practitioner quite rightly considers (hat he has sufficient skill to treat the patient adequately and wants to retain that patient, is that patient going to be satisfied? What has happened to the great myth of 1949 of patient-doctor relationships which we heard from the present Parties when they opposed the Australian Labor Party’s health scheme? What does this Bill do to doctor-patient relationships? It almost destroys any confidence which the patient has in the doctor. Then as the expertise of the medical profession in the States where the highest fees are paid is built up the patients from the lesser paid States - those in the States which have a second class service - will want to go to the other States to obtain expert attention. In this way the cost of health to the patient will be increased. The Bill does nothing to try to avert this development. The maintenance of good health becomes more expensive every day. It has been proved throughout the world that medical costs are highly inflationary. The Government is not making any attempt in this legislation to hold costs down. Costs will increase and as they increase over and. above the list of common fees the patient will bear more of the costs.
Government advocates are being completely dishonest when they stand in their places in the Senate and say that the patient will pay no more than $5 whether it be to a general practitioner or to a specialist. That position will operate only if the specialists adhere to the list of common fees and it cannot operate in any other way. But, of course, this scheme was conceived in panic when it was put to the Australian people during the election campaign. The Prime Minister (Mr Gorton) Had no idea of what it was going to cost gr how it was going to work out and this is borne out by the escalation of the costs of the scheme. In various ways it has risen now by S65m and this is part of another burden that the people will have to pay for their health. They will pay greater contributions to the proliferation of funds. It just seems to me that the whole scheme does not work out.
The Bill throws up so many anomalies that neither the patients nor the doctors will understand where they are. I think this is inherent in the amendment moved by Senator McManus on behalf of the Democratic Labor Party seeking more time to come to an agreement with the members qf the medical profession. I do not agree, of course, with giving them more time. They have had since last September, when the Prime Minister made his announcement, o work out some compromise on this and the inability of the doctor of philosophy to work out an agreement with the doctors of medicine has led to the shambles that the medical profession is in today. The confusion within the medical profession is revealed in the amount of correspondence that we have all received from the Australian Medical Association and the general practitioners. If honourable senators sit down and study that they will find just how confused the whole of the medical profession is. It clearly points up the divisions in the ranks of the profession but, of course, this is the old conservative approach - to divide and conquer - and in this instance the Government has set put to divide and conquer the medical profession. If it has done nothing else it has done that. I say that this can only reflect upon the patients.
The specialist does not have to worry very much because the patients will be anxious to get to the specialist and they will be demanding that the general practitioner refer them to the specialist. It is not sufficient to say, as Senator Webster said, that they can only go to the specialist if they are referred by the family doctor. This is the position with the legislation of today. The Commonwealth pays 2 fees. One goes to one’s general practitioner and he refers one to a specialist. I do not know any general practitioner who has refused to refer a patient on the patient’s request. Of course that will happen under this legislation, too. The patient will make a request for specialist treatment and the general practitioner will have no option but to refer that patient to the specialist. Of course, the specialists will be centred in our cities and larger towns. These are the only places where specialists can operate, where the facilities are available for them to carry out their specialist treatment and it means an exodus to the cities and the larger towns from the smaller country towns.
The result of this, of course, will be that there will have to be some subsidisation of general practitioners to enable them to continue to practise in the smaller country towns. It will not be the Commonwealth which will be paying the subsidy to the general practitioner in the country town. This will become another burden on State finances. The problem of CommonwealthState financial relations has not yet been resolved but I believe that this legislation will increase the financial burdens of the States. I know that it has happened over the years in my own State. The State Government has had to pay subsidies to medical practitioners to operate in the small gold mining towns and in the north west part of the State the State Government has paid the air fares to the cities of patients requiring specialist treatment. There will be much more of this as this legislation starts to work through and it will be a greater burden on the States. With no guarantee from the medical profession that the list of common fees will be adhered to, has the Government given any consideration to the burden that it is building up for the public to bear for health? Surely the medical practitioners are not going to be the only ones in the community who will not require or take - whichever way one likes to put it - an increase in their remuneration, and there is no provision in this Bill for an escalation of the benefits that are provided by it to catch up with the increase in medical charges.
I will be surprised if the medical practitioners leave their fees as they are today for any lengthy period. Like everyone else in this community under this inflationary spiral that this Government loves so well they will be wanting an increase in their fees. It will be the public who will pay, and not the Government. The Government, of course, made one other promise during the election campaign last year. It also agreed to ease the burden of income tax upon the low and middle income group. Those who are able to pay for medical services at present will not be in greater difficulties under this Bill than they have been in the past, but those in the low and middle income groups will be in greater difficulty. If ever the Government gets round to implementing its policy of reducing taxation on those in the low and middle income groups it will give with one hand and take away with the other. That is exactly what this legislation proposes to do.
I can do little more at this stage than to commend the amendment moved by Senator McClelland. It is designed to ease the burden on those in our community who are most in need of help. It is designed to make those who can afford it pay and to contribute a little for those who cannot afford to pay. I commend this proposal to the Government and ask that honourable senators agree to it. Many honourable senators will say that they cannot agree to this because it is Socialist legislation, but as 1 have watched the political scene in Australia over the last few years I have noticed that it has not been the Australian Labor Party that has been turning more to the right but the Liberal Party of Australia which has been turning more to the left. This is inherent in the squabbles that have been going on in the Liberal Party at the moment over the Industrial Development Corporation, off-shore oil and this type of legislation. Senator Greenwood laughs.. I know that a few years ago the Menzies Government implemented compulsory loans. When we tried to nationalise the banks the people were told that we were going to seize their savings, but the Menzies Government seized the people’s savings out of their insurance accounts and out of their superannuation funds. Not a word was said about that. So let us not talk about where the Conservative Parties aTe going. They know that for their very survival they have fo adopt Socialist measures.
I say to the Senate that within a very few years the Government will have to adopt this policy of compulsory contributions and it will have to adopt a policy of compulsory common fees. This is the only way in which a national health scheme can be made to work. The writing is on the wall. When we examine schemes in other parts of the world - I do not stand up for any particular scheme - we see that the so-called free enterprise schemes that operate in other nations are falling down and that the people are crying out for something better. This Government has an opportunity at this stage to provide something better at little cost to itself. The cost will be very great if it allows the opportunity to slip away. It should be implementing the scheme now.
Why does the Government try to shore up this scheme which is without foundations? It knows that it is without foundations. The Commonwealth Committee of Inquiry on Health Insurance, known as the Nimmo Committee, told us that it was without foundation, and the Senate Select Com’mittee on Medical and Hospital Costs told us that it was without foundation, yet the Government, in pursuit of its so called free-enterprise policy - it is free only sometimes, not always - will persist in wasting millions and millions of dollars of the taxpayers’ funds in shoring up a scheme of thin nature. I commend to the Senate the amendment moved by Senator McClelland. It is the only sensible way out. I would have wished that the amendment went a good deal further and covered many more of the things that should be covered. However, the amendment will relieve the burden of payment by the people and 1 commend it to the Senate.
– It is difficult to appreciate that Senator Cant has been relying upon the rhetoric of an old style Labor Party politician to castigate this Bill. It is difficult because I know that he has read the Bill and because he is the type of senator who applies himself to his work, but if the matter of the Bill was read, the text examined and the many speeches made by the Minister for Health (Dr Forbes) appreciated, what Senator Cant has said would be seen to lack any foundation. This Bill will give, as its terms and its practice demonstrates, financial protection to those persons who from time to time have to bear the heavy costs of medical and hospital treatment. This is what the Bill is designed to do. It will achieve that object. I propose, in the short time available to me, to demonstrate as well as I am able that that is the objective of this measure.
– What about the man who has a coronary?
– What about the reserves that the funds have?
– If honourable senators will only bear with me they may have questions to ask when I have finished. I wish to stress that when a person is faced with the prospect of heavy medical expenses, which are usually unexpected, and a heavy hospital bill he expects in some way to be able to meet the expenses without financial hardship. So often that cannot be done. I do not care what members of the Opposition might say as to the obligation to provide some national medical and health scheme - expressing it in language which is vague and general and not condescending to the particular - I believe that the function of government is to help people when they are faced with financial hardship. That is what this Bill is designed to do. It will ensure that the individual who is prepared to engage in a little self-help and who will register himself by insuring with a fund will receive not only the benefits which the fund will provide for him but also the benefits which the Government will provide. He will have to provide some amount himself, but in no case will that exceed $5. There is a continuation of Government help for those who are prepared to help themselves.
I have sat and listened to Senator Cant who preceded me for approximately half an hour. He engaged in what I said was the ideology or rhetoric of the old time Labor politician. I suggest that if ideology is involved in this measure - I think it is - it is the voluntary principle which the Government Parties stand for and the compulsory principle which is implicit in the platform of the Australian Labor Party and in what it suggests as its proposals in this area. I think it is important that this Bill should be properly appreciated because it ought to be recognised that it imposes upon an individual an obligation to do something to help himself. The Parry to which I belong has always enshrined as one of the fundamentals in its platform and as one of the objectives towards which it is striving the development of individual initiative and individual responsibility. This is what the Bill is doing.
What are the alternatives which a government may face in order to meet the situation of hospital and medical costs which individuals may find themselves called upon to bear from time to time? I suppose the first alternative is that an individual can save out of his own resources and be expected to meet any contingency which arises. This, I suppose, is the highest degree of responsibility, yet in practice it will not work out. It will not operate because individuals, being what we are, are always inclined to draw upon what we put aside for the rainy day or, in many cases, we have not the means to put aside for the contingency which may arise. So notwithstanding its appeal as the highest degree of responsibility, practice has demonstrated that to rely upon individuals to save to help themselves is not an effective way of ensuring that people will be able to meet the hardship of high medical and hospital costs.
The second alternative is that the Government should in some way provide medical and hospital services for every citizen in the community. As I understand the platform of the Australian Labor
Party, that is what it would do. It would provide a State-wide nationalised medical service which would be available to any citizen who wanted to avail himself of it. It would maintain and develop State hospitals and anybody who wished to attend those hospitals could do so free of charge. I appreciate that that is a tremendous attraction for a person who feels he ought to be safeguarded against any illness or operation he might have to undergo. But I think there is a vice in that scheme; - I will deal with it in a moment - which ought 10 be overcome by a system which applies some responsibility to the individuals themselves.
The third alternative is a scheme which recognises that there is an obligation upon the Government to provide financial assistance and yet calls upon an individual to help himself. That is what this scheme envisages. Indeed, it is what the national health scheme has always recognised since it was introduced by Sir Earle Page in 1953. 1 wish to refer to what Sir Earle Page said in 1953 because I think he put succinctly the policy behind the current national health scheme. He said:
The great danger in any government aided health scheme is the tendency to develop a psychology of dependence and diminished personal and community responsibility. The fundamental aim of any social security scheme should be to raise the individual to a level at which he cao help himself. Any such scheme should contain elements that encourage self-reliance and a sense of personal responsibility. Also it should stress the obligation of the individual to make at least apart of his contribution directly to the functioning and cost of the scheme. The Government is doing this by a unique device of stimulating voluntary insurance by government aid, which tremendously increases the value of the premium in medical security.
That was stated at the time of the introduction of the scheme in 1953. I think that over the years the Government did not do as much as it should have done.
– That is an admission.
– I concede that, if there is any point in it for the honourable senator. But what is now happening is that in this Bill there is the culmination of the policy which John Gorton initiated from the day he became Prime Minister. It is a scheme which embodies the principles which were inherent in the original national health scheme. Those principles seek to promote self-reliance and to ensure that government aid is available to those people who will help themselves. I wish to elaborate on my statement that this Bill is the culmination of a scheme to which the Prime Minister personally committed himself.
The departmental committee, which became known as the Nimmo Committee, was set up early in 1968. Its major recommendations are incorporated in the present health scheme proposals. The recommendations of the Senate Select Committee on Medical and Hospital Costs have also been an advantage to the Government in forming these proposals. Early in 1968, after the present Prime Minister took office, the health scheme enabled chronic illness to be covered absolutely. Substantial grants were made to the States to provide housekeeper services, home care for the aged, some paramedical services and assistance of that character. Throughout 1969 there was continuing controversy in the field of national health. Amendments were made to the National Health Act in September last year so that persons and family units in receipt of an income of less than $39 a week would receive not only free government assistance to meet medical and hospital costs, but also free fund benefits for the same objective.
During the election campaign in 1969 a clear cut issue was placed before the people. They were asked whether they wanted a health scheme which embodied the voluntary principle - that was the proposal put forward by the Government - or whether they wanted a compulsorily financed scheme - the policy put forward by the Labor Party. Since the Government was returned to office there has been a tremendous surge of activity. In March this year, on the second day of this session, a very elaborate statement was made by the Minister for Health, in which he set out the broad outlines of the scheme now embodied in the Bill before the Senate. I think it is fair to say that when this measure is passed and comes into operation early in June, as it is hoped, it will be the culmination of a scheme which should give, as the Minister has frequently stressed as his objective, financial protection against the costs of medical and hospital treatment.
– Will give or should give?
– It should give that protection, and it is believed that it will. I think it is worth studying the way in which the scheme operates. Although this is a Bill of complexity, the essence of the scheme is quite simple. An individual must register with a medical benefits fund. When he registers with the fund he is entitled to receive a rebate or refund in respect of medical or hospital costs incurred by him. 1 will cite some examples, taking Victoria for the purpose, as that is my home State. The common fee figures vary from State to State. In Victoria, in the case of a visit to a doctor’s rooms the total cost is $3.20. A person registered with a medical benefits fund will receive from the Commonwealth a benefit of $1.10. The fund to which he subscribes will pay $1.30 and the patient will pay the balance of 80c. That will be the situation each time he visits a doctor at his surgery.
When a doctor visits a patient at home in Victoria, the most common fee in those circumstances is $4.50. The Commonwealth contribution will be $1.65 and the medical benefits fund to which the patient belongs will also contribute $1.65. The patients will be required to pay the balance of $1.20. Turning now to operative procedures, the most common fee charged in Victoria by a general practitioner to remove an appendix is $60. Of that amount the Commonwealth will pay $36; the medical benefits fund will pay $19; and the patient will be required to pay only $5. When a patient is referred by a general practitioner to a specialist for an appendectomy, on a most common fee basis be will have to pay $80. If he belongs to a medical benefits fund he will receive a Commonwealth contribution of $42 and a fund benefit of $33. He will have to pay no more than $5 for the operation.
One might ask: Why should he have to pay $5? Why should he when he visits a doctor have to pay 80c? Why when a doctor visits him at home should he have to pay $1.20? I suggest that the reason why he should pay those amounts is because they are within the means of every Australian and an individual should accept some responsibility to look after himself and to contribute towards his own hospital and medical treatment. By requiring these amounts to be paid the basic voluntary insurance principle is maintained. I believe that this is one of the factors which, from the Government’s point of view, commends this scheme above any other scheme which is tax financed and compulsory in its essence.
There are other advantages in the scheme. I suggest that the first advantage is that any voluntary insurance scheme of this character provides an element of choice. A patient may choose the doctor he wishes to visit I believe that that ought to be a consideration of weight in any health scheme. Secondly, it permits a degree of patient responsibility. When there is a state provided, compulsory, tax financed scheme which is available to anybody to use when and how he pleases, there is always the risk that the scheme will be abused. I think the pattern of experience in the United Kingdom is that people will use the free hospital and medical services that are available there to an extent of overusage.
– Would the honourable senator say that of Queensland?
-! will not say that of Queensland because I cannot speak with any knowledge of the position there. What I will say of Queensland is that it has a free hospitals system. There is undoubtedly a risk of overusage, which has been testified to in the United Kingdom. That is always a risk when a state financed scheme is freely available to anybody who wants to use it. I believe that on the ground of cost, if for no other reason, that is something to be avoided. But I would prefer to put it on the basis that some degree of patient responsibility is involved if a patient knows before he goes to a doctor or before he embarks upon some hospital treatment that there is still some measure of cost that he must bear.
A further point is that any compulsory scheme, and particularly one that would be operated in the form the Labor Party suggests in its platform, would provide a uniformity, an institutionalised complex and a lack of the personal attention and personal service which a person does receive now from a doctor to whom he goes. Under any scheme along the lines of the one for which the Opposition has been contending - .1 must concede that members of the Opposition have not given it much publicity here tonight - the patient would go to the office or to the counter and would be dealt wilh in his turn by one of the State doctors or, in one of the State hospitals, by a State, institutionalised service. I am not suggesting that the people who would staff these services would not be dedicated people determined to do their best; but they would be servants of the state and in fact they would be in an environment (hat breeds that type of attitude which as we have heard many times from members of the Opposition, is to be found in any government run show. I believe that it is preferable to avoid that if it can be done. Again it is basic to the Government’s scheme that what is involved in this national health scheme will ensure that.
A further point iri favour of this scheme as against any state financed or tax’ financed, compulsory scheme is that there is no civil conscription of doctors. I think doctors are the only constitutionally guaranteed free people in Australia because under the Constitution services may be provided by government but only in such form as does not amount to the civil conscription of doctors. I believe that any scheme that seeks to fix the fees that doctors must charge is a form pf conscription which would be unconstitutional.
– ‘Conscription’ is a dirty word.
– I am saying that in 1948 the High Court of Australia held invalid a Labor Party scheme that required the doctors to do things which I would have thought were far less onerous than adhering to a compulsory fee scale. The High Court held the medical scheme that the Labor Party then put up to be invalid because it involved some conscription of the doctors. Any scheme which has been mooted by the Leader of the Labor Party over the past 12 months and which sought to fix a scale of fees that doctors were to observe would be unconstitutional because it would be an infringement of a constitutional provision.
The present scheme which the Government puts forward has as its basis a common fee which the Government hopes the doctors will observe. As I understand the position - this is contrary to what Senator Cant suggested - the doctors have indicated a willingness to adhere to this common fee. Indeed, one of the .points of controversy between the Minister for Health and the medical profession at the beginning of this year was whether the doctors would be prepared to adhere to a common fee.
– Has that been resolved?
– 1 understand that it was resolved after an examination had been made of the proposals as to what was to go into the common fee. I think it must be regarded as basic to this scheme that the common fee should be observed. Equally I believe that it is important that there should be provision for this common fee to be reviewed regularly. I imagine that, if it is not reviewed regularly, in a very short time the real benefits that this Bill is designed to guarantee will be lost. For my part, I believe that there is every degree of prospect of co-operation if the common fee scheme is maintained so that the levels of common fee coincide broadly with the levels of charges being made by the doctors.
I have spoken on this occasion because I believe that it is important, before one gets down to an examination of the details of this Bill, to stress the broad philosophical background behind the measure that is now before us for consideration. I believe that the Minister for Health is to be congratulated on what is the culmination of a tremendous job of work. He had an enormous task in getting this scheme into the drafting stage. He had tremendous difficulties in assuring the doctors of what was involved in this scheme. He has had a tremendous field of negotiations over a long period in recent times. He has travelled the length and breadth of Australia explaining his scheme to meetings of doctors.
Whilst there are areas of doubt and whilst there are particular points that I believe have to be watched and surveyed carefully as the scheme develops, what has been proposed offers fair prospects of providing a medical and health scheme which has been unequalled by what has been put forward so far. I appreciate what has been said about the problems that will beset the general practitioners if there are differential rebates or differential common fees according to whether a patient goes to a specialist or to a general practitioner. I appreciate that there will be a tendency for graduates to become specialists. I appreciate that there will be a tendency for general practitioners to move into areas of specialty. I appreciate that there will be problems in country areas. I am not sure whether this situation is to be overcome by having a single fee. I am not sure that it will not be overcome by the requirement that specialist fees will be payable only where the patient is referred by a general practitioner, as is proposed in this Bill. These are areas of doubt, and I will be interested to hear what is said on them at the Committee stage.
However, this is a measure which, as I said, will bring financial protection against the costs of medical and hospital treatment and will do so in accordance with certain basic principles which this Government has always recognised and which emphasise that patient responsibility, individual responsibility and the willingness of individuals to do something to help themselves ought to be fundamental in any health scheme. Because this measure has these things involved in it, I believe that it is deserving of the approval of the Senate. In particular, f believe that the Minister for Health is deserving of the commendation of this Parliament and that what he has done ought to be recognised.
– The important legislation that is now before the Senate has had an extremely unhappy history. It has had an unhappy history in contemplation, in negotiation and in the confusion among various sections of the medical profession, but particularly in the incredible manner in which finally it was presented to this Parliament. It was presented in the House of Representatives in circumstances in which, although a major Bill with major consequences, it was guillotined through that chamber on a very strict time schedule, lt is, more incredibly, presented in this chamber in circumstances which particularly prompt me to rise to support Senator McManus in his contribution in this debate. I, and other members of the Australian Democratic Labor Party did not intend, because of the importance of this legislation and the desirability of its principles being considered, to speak specifically to the principles of the Bill which Senator McManus adequately covered but, as I say, a situation has developed which makes it important that the Democratic Labor Party should be heard at this stage of the debate.
Senator McManus, on behalf of the Democratic Labor Party, welcomed the Bill in that it marked a substantial advance in the provision of health and medical benefits and treatment for the Australian public. He pointed out, however, that there was a situation as yet unresolved and one which if properly resolved and written into this legislation could embark it upon a course which would make for much happier operation and would virtually guarantee the success of the legislation during its lifetime of operation. The proposal of the Democratic Labor Party is that in view of the fact that there is still a difference of opinion in branches of the medical profession, between general practitioners and the other branches of the profession, this legislation should be delayed until the holding of a most significant meeting which the Australian Medical Association has convened in a last endeavour to reconcile the varying views and which could well result in a common proposal finally emerging for consideration by the Government and for incorporation in the legislation. The meeting is being convened for 1st, 2nd and 3rd June. That is only about 10 or 12 days from the present time, and I, and the Democratic Labor Party, can see no reason why this legislation should not be held over until that most important meeting is held. A decision might well emerge from the meeting which would be welcomed by the Parliament and incorporated in the legislation. We are at a loss to know why the Government, which has set the mystical date of 1st June for introduction of the scheme, is not prepared to accept our proposal.
We are even more amazed that the Australian Labor Party seems to join common forces with the Government to ensure the precipitate passage of the legislation in this chamber, the Labor Party having protested about the same procedure being adopted in another place. We have been unable to persuade members of the Labor Party, as yet, that the appropriate, proper and prudent thing is that this legislation should abide about another fortnight, after years and years of consideration and months and months of negotiation, until this final opportunity is given to the Australian Medical Association to present to this Parliament a scheme which can be embodied in the legislation, lt is for that reason that I rise at this stage to draw attention to certain aspects of the nature of the passage of the Bill through the Senate.
The Australian Labor Party has presented an amendment in this place to the motion for the second reading of the Bill. It suggests the establishment of a national health commission. We have proposed an amendment that the further stages after the second reading stage be delayed until a decision is made by the meeting of the Medical Association and that decision can be discovered. But tonight in this place we have been presented with a list of 30 substantial amendments from the official Opposition going to the very heart and nature of many proposals in the health legislation. We know that in another place amendments in great numbers were also produced. ‘We are not represented in anoother place. We did not have the amendments before us1 and, as I understand it, these amendments come to this place, if substantially the same in substance, different in form from the amendments which were presented in another place. The Democratic Labor Party is now asked to consider 30 amendments at virtually no notice. I am not altogether blaming the Australian Labor Party for the belated circulation of these amendments. It may have had certain mechanical difficulties.
– They were not printed.
– I understand that, but as a matter of fact, these 30 amendments were presented to the Democratic Labor Party, and to other honourable senators in this place, possibly only 2 hours ago. There is no way in which these amendments - many of them of very great substance and going to the fundamental texture of the National Health Act - can be considered adequately by our Party.
– Or by anyone.
– Or by anyone, as Senator Turnbull suggests. If these amendments are the same in substance as those presented in the House of Representatives, then at least it can be said that the amendments no doubt were considered at the Party meetings of the 2 parties represented in that place. We have not had a Party meeting to consider these amendments at all. Yet we are now asked, if we proceed immediately to the Committee stages, to consider the amendments and to give a deliberative vote on them. This is the position facing a Party such as ours which as a matter of fact has a significant mathematical position in this chamber and whose vote can be significant on these issues. What is the Party to do? We are not dealing with minor technical amendments. On a quick glance through them, there is, for example, and amendment that goes to the repeal of a certain section in the principal Act which the Government now proposes to amend. An amendment of the Australian Labor Party is to discard the amendment and even to repeal provisions in the principal Act. So far as I can see, that type of thing runs through many of these amendments. These are substantial amendments. The fact that the Australian Labor Party sees the necessity to present so many amendments to an amending Bill, which is the most substantial amendment to the Act for many years, indicates the significance that the Labor Party attaches to them, and it is a significance that neither we nor the Government can afford to overlook.
I ask: Does the Government concede the difficulty of our position? Does it concede the right - not only the right, but the responsibility - of the 4 members of the Democratic Labor Party, whose vote may be decisive, to examine all these amendments in detail? I would suggest that the Australian Labor Party might review its attitude to the amendment we have proposed. We have proposed an amendment that contemplates the delay of the next stage of the Bill for a precise reason. It could well be delayed for reasons in addition to that, and those are the reasons I have now advanced to the Senate, such as that there are substantial amendments which must be considered. The Australian Labor Party therefore might well have a second thought on our amendment and seize the opportunity to support that amendment because that would enable its own amendments to be considered. We could do 3 things in relation to these amendments. We could abstain from voting. That, in a sense, would be the logical thing to do. We have amendments which we have not had time to consider. They are important amendments. It is difficult for us to arrive at a decisive conclusion on them and it would not be expected that we would be able to do it. What are we to do? Are we merely to oppose the amendments in order to preserve the status quo? Would that be the logical thing to do? Or are we to support the amendments? More logically, would it not be that we should abstain totally from voting on them? In view of the mathematical distribution of numbers in the Senate, abstention from voting would, in effect, mean the carriage of the amendments and the defeat of any opposition by the Government to them. That is the third alternative course that may be available to us. But these are the courses that the Democratic Labor Party will have to consider and is considering at this stage.
Only the other night in this place an amendment was circulated very late by the Democratic Labor Party to amend the Estate Duty Assessment Bill. We proposed an amendment on the third reading of the Bill. The Australian Labor Party complained that notification of the amendment came very late. It was inevitable that it would be late. The Labor Party said: ‘This is an important matter. We should have time to consider it.’ The difference between that position and this - and the Labor Party complained on that occasion - was that it was neither an operative amendment nor an operative request. It was only an amendment to indicate that the Senate felt the Government should look at the whole question of estate duty with a view to its elimination. That was all it was. The Australian Labor Party said: ‘This is an important matter, we require more time’, although within its own amendment the Labor Party set ils face against the duplication of the incidence of Federal and State estate duty, which it considered sufficiently important to protest about. These amendments are not pious resolutions. In terms of the forms available to the House they are requests. This being a money Bill we cannot amend but we can request. We can do something here that even the House of Representatives was unable to do. The House of Representatives was unable to consider these amendments in the form of an amendment because in that House their presentation had to be preceded by a message from his Excellency the Governor-General. That system does not operate in this place. The Senate can adopt these amendments as requests without requiring any prior message from the Governor-General. Therefore these are operative provisions which are now presented to us.
For this reason we look for a response by the Australian Labor Party to our proposal that time should still be available to consider these amendments and generally to consider the Bill and more particularly to allow this latest, we hope, decision of the medical profession to be determined, announced, accepted by the Government and incorporated in the legislation. This is another reason why that course should be adopted and our amendment accepted. But failing that, if the Government is not prepared to concede the sheer cold propriety of some delay now in the passage of this legislation, there is another course available to us and we should attempt it. Senator Turnbull, who has supported the amendment of the Australian Democratic Labor Party, has suggested that if our amendment were defeated he would move in the Committee stage that the Committee forthwith report progress and ask leave to sit again on a later day or some days later. We would support such a proposal, and at least in that respect we would expect the cooperation of the Australian Labor Party if for no other purpose than that its own amendments could be considered adequately, not only by members of the Democratic Labor Party but also by all members of the Senate who have not as yet had the opportunity to consider them in detail.
This is important legislation. We accept and we support the principle of the Bill. We are opposed to the amendment moved by the Australian Labor Party against our own amendment, moved by Senator McManus. However, this kind of proposal is included in the general social policy of the Democratic Labor Party. We still think that the opportunity must not be lost. If this legislation can be presented to the nation with the realised expectation of the people themselves and with the goodwill and cooperation of the medical profession, its future history will be totally different from what it will be if it is virtually imposed on as yet a disorganised point of view of the medical profession but a point of view which may well be clarified and polarised within the next 10 days. It is absolutely indefensible that we should neglect the opportunity which still presents itself. The medical profession will be meeting on 1st, 2nd and 3rd June and probably will come to a decision which, had it been arrived at a fortnight before would have been incorporated in the legislation, but will then bc completely useless and worthless if the legislative opportunity has been neglected, perhaps for all time, to carry it into effect.
Surely that will riot be the attitude of the Government or of the Senate. No good reason has been advanced why this proposal should not be accepted. The conference of the medical profession will take place on 1st, 2nd and 3rd June and the Parliament will be meeting at the end of that week. If a proposal came from that body it could be immediately carried into drafting, incorporated in the statute if it were acceptable and the Parliament would be available forthwith to deal with it.
– What if it is not acceptable?
– If it is not acceptable there would have been a delay of about a fortnight. Surely a delay of about a fortnight from, say, 1st to 1 1th June is not too long a delay if it will provide an opportunity to do what I am suggesting. But if it is acceptable all that would have happened would have been a delay of 10 or 11 days, opposed to which we will have a proposal which will be accepted with the goodwill of the whole of the medical profession for years to come. The original legislation which we are now proposing to recast has stood for so many years that we can anticipate that a good scheme will stand equally for a long period without substantial amendment. Why should it not be the best scheme that we can give?
We are concerned not only with the individual subscriber to a medical benefits fund. We are concerned also with the health of the nation and with the availability of proper health and medical services to the nation. As Senator Turnbull has pointed out and as Senator McManus has stressed, we will face a grave dearth of general practitioners if the trends which will manifest themselves in the light of the proposed legislation are allowed to develop. That will be a tragedy for the nation. While we might have got some quick legislation we will have lost in the ultimate a good, extensive and diversified medical scheme with a ready supply of general practitioners whose proper place in the scheme of medical practice will have been accepted and embodied in the legislation. Surely those are considerations which warrant the adjournment of this legislation for only a fortnight.
If the Government is not prepared to do that, I can only suggest that some other factor must be affecting its judgment because all the logic is behind this proposition and I would expect that we would obtain the support of the Australian Labor Party. There are only 14 days or so in question. The medical profession is on its last opportunity. It will know that and will know that if it cannot come up with agreement within its own organisation and with an acceptable proposition, then the Parliament is waiting to give its signature to the Bill substantially in its present form.
– What about the equity of the subscribers to the funds? Are you not giving them any consideration?
– This is a Bill intended by no means only for the benefit of the doctors. The implication behind this is not that there may be some equity for the doctors but it is a means of ensuring the best medical services for Australia by the continued provision of general practitioners who will be available in the far flung towns and hamlets of Australia where their work substantially is. That is what is behind the proposition that we now present to the Senate. Surely any Australian knowing the Australian scene, knowing the difficulty which is continually apparent, and which is becoming increasingly apparent, of obtaining general practitioners in the far flung areas of Australia must agree that if this will aggravate the position then the situation is intolerable.
I do not regard this merely as a battle of political tactics or something of that nature. This is essentially important. How would honourable senators feel if they were members of the federal body of the Australian Medical Association due to meet on the 1st, 2nd and 3rd June in an attempt to resolve this matter of such fundamental importance to the profession, to the patients and to Australia, and in the face of that this Parliament were not prepared to wait a fortnight to see a resolution emerge from that body? How would honourable senators feel? What would be their approach to the future organisation of the scheme?
– The Association has had weeks to look at this.
– We know that it has taken weeks and we know that negotiations often take a long time. The Association knows that time is running out and this Parliament will make it completely clear that time has virtually run out and that it is really an extension in solicitude and regard that we give them the lust 14 days. ls it too much to deny the medical profession thai? ls it too much to deny to the Australian people the best possible cooperation from their medical profession? ls it too much to deny to the Australian people the best possible supply of practitioners in the future merely for the sake of meeting some mythical date - 1st June - to which no-one has given any particular significance?
– What about the offshore legislation?
– 1 am reminded by Senator McManus that in almost similar circumstances where the Government was faced with a lack of co-operation from the contracting parties - the States - in relation to the off-shore minerals legislation, and it looked as though something would emerge, not in a spirit of co-operation but in a spirit of the imposition of power and authority by one source, good counsel has prevailed and wise judgment has had its way. 1 understand that there will be a delay now in the presentation of the off-shore minerals legislation. This is a complete parallel with the present situation. If it was good enough to delay the legislation on that occasion in a situation of intense politics, as we know it was. why is it not good enough to do so on this occasion?
Mr President, 1 appeal to the Senate with all the sincerity I can command: If the Government is unable, in spite of the reasons the DLP has outlined in its proposed amendment, to postpone the further consideration of the Bill, until the final opinion of the AMA has been discovered it should, for the additional reasons I have given - because of the importance and significance of the multiplicity of proposed amendments which we have not had time to consider - agree to report progress in Committee so that the opinion of the AMA can be discovered some 14 days hence and the proposed amendments can be considered in detail. 1 commend that suggestion to the Senate. This is the last opportunity this Parliament will have to launch a health and medical scheme which will be accepted by all sections of the Australian community.
I support the amendment which Senator McManus has proposed on behalf of the
Democratic Labor Party. I appeal to all honourable senators to support it. If they are unable to do so, L appeal to them to agree to report progress in Committee so that this and other matters can be considered in the relaxed and detailed manner that such important considerations deserve. 1 commend Senator McManus’s amendment to honourable senators.
– I support the amendment which was so ably moved this afternoon by Senator McClelland. 1 believe that it is in accordance with the desires of the people of Australia. I think it is very: important always to remember that one should try to estimate and judge the views of ‘the people of Australia and make one’s decisions coincide with their balanced views. Firstly, I wish to deal with the appeal of the Australian Democratic Labor Party to the Senate to withhold the passage of this legislation until such time as the result of the meeting of the Australian Medical Association on 2nd and 3rd June is known. I consider that if the AMA was so concerned about having its new views reported to the Government it would have been an easy matter for it to hold a meeting at a much earlier date than 2nd and 3rd June. The situation is that the Government has turned its back on the AMA. Consequently, is there any reason to believe that the Government will support any resolution which is carried by the AMA at its next meeting? In view of our experience in relation to this legislation it is doubtful whether the Government would do so. Therefore, I can see no real merit in the argument that we should await the decision of the AMA at the meeting which is scheduled for 2nd and 3rd June.
In relation to the amendments which the Austraiian Labor Party proposes to move in Committee, I submit with respect that ali honourable senators have had ample opportunity to determine their attitudes to the proposals. This legislation was introduced into the other place on 13th April. lt was debated for 3 days in Committee The amendments that the Australian Labor Party proposes to move in this chamber will be substantially the same as those which were moved in the other place and which were debated for 3 days. Consequently, I suggest that it is quite reasonable to assume that all honourable senators have had an opportunity to determine their own views on these matters because they should know what the Labor Party will be moving in Committee in this chamber. 1 believe that the appeal of the Democratic Labor Party fails on this ground.
I do not propose to deal with this legislation extensively. However I believe that history will show that this legislation is one of the most tragic pieces of legislation ever to be introduced into the Parliament. There has been so much division amongst supporters of the Government, the Australian Medical Association and various pressure groups that the way in which the various provisions of the legislation has been bandied about in the countryside in argument and discussion has become really ludicrous. But the legislation is now with us and it is therefore our responsibility to try to improve it to the best of our ability.
I am sorry that Senator Greenwood is not present in the chamber. I believe that his contribution to the debate tonight was so cynical as to beggar description. He has made a comparison between the proposed scheme and the free hospitalisation scheme which is in operation in Great Britain. He did not have to go that distance. He could have made a comparison between the proposed scheme and the free hospitalisation scheme in Queensland. Senator Greenwood relies for his information on something he has read about Great Britain’s free hospital system. He came into the chamber tonight and without producing any evidence whatsoever said that people who do not pay some part of their medical costs will over-use the services provided. What if some people do over-use these services? I would suggest that they would be in the minority, anyway. What about the people who go along for free hospital services because they cannot afford to pay for the services of a medical practitioner? If a free hospital service were not available to them it is quite likely that they would become very sick indeed. If that happened they, would become a burden on the community.
It is all very well for Senator Greenwood to say that everybody should pay part of his hospital expenses. The fact is that some people are in difficult financial positions and do not have the wherewithal to pay the fees of a medical practitioner. In those circumstances they become a burden on the community inasmuch as they cannot attend their work place and therefore do not receive any wages. Consequently, they have to be granted social services. Although a minority of the community may over-use the services, I believe that that minority should be overlooked in view of the fact that the people who comprise this minority can go along and receive adequate treatment which will enable them to be productive units in industry. Senator Greenwood said that if we had free hospitalisation, patients would be lining up before doctors or public servants and would be treated in a cavalier manner. This has not been the experience in Queensland. Honourable senators from Queensland will confirm the accuracy of my remarks. It is quite wrong for Senator Greenwood to make accusations against the medical profession and public servants generally and to imply that they have no interest whatever in the welfare of the people.
I wish to address myself to some aspects of the second reading speech of the Minister for Housing (Senator Dame Annabelle Rankin), who represents the Minister for Health (Dr Forbes) in this chamber. The Minister said:
The Bill provides for the fund benefits payable by organisations to vary from State to State and consequently it will be necessary for the contribution rates charged by organisations also to differ accordingly.
On 5th March 1970 1 asked the Minister a question in relation to this matter. My question has not been answered. I would appreciate it if the Minister, when she replies to the debate, will explain the matters I have raised in my question of 5th March.
– What is the number of the question?
– It is No. 86. My concern is for the worker who may be working in Queensland, South Australia, Victoria or another State and who contributes to a fund. At the request of his employer, he transfers his employment to New South Wales. Under those circumstances is he required to pay additional contributions? Is he still covered by the contribution he paid in his home State? What is the position? I asked the Minister to endeavour to answer, that question because it raises a difficulty. I will not say any more about the question, except to say that it is question No. 86 of 5th March 1970. The Minister, in her second reading speech, referred to the eligibility level for full health insurance for low income families to $42.50 per week. The Minister said:
The Bill also provides for graduated assistance toward the costs of contributing for health insurance to families with weekly incomes not exceeding S48.50.
At an earlier stage I indicated to the Senate that many workers were in receipt of a wage less than the amount proposed at that time. I had a table prepared indicating the minimum wage paid in all States under Federal awards. Unfortunately, the Minister elected not to allow leave to have that table incorporated in Hansard. Consequently honourable senators were unable to see that table. Nevertheless I expect that the Minister contacted the Department of Labour and National Service and had a copy of the table made available. I do not know whether that is so, but I assume that it would be so. Under the present circumstances the $42.50 does not mean a great deal because as from Friday, 15th May, the minimum rate paid under State awards in Queensland is $42.80. Honourable senators can see that the $42.50 is exceeded already. I submit that quite a number of employers pay wages over the award. If we assume that employers pay $1 a week over the award, the weekly pay would be $43.80. It is true that the Bill makes provision for some gradual process up to $48.50, but it does not need a great deal of imagination to figure out that the worker on the $42.80 base rate would not have to work a lot of overtime to take him past the highest point for which the Government caters, and that is the $48.50. Consequently, it is not easy to nominate a figure and say that X number of workers or people in the community will benefit.
Would the Minister please explain what machinery will be used to determine the rate. Is it a weekly wage? I asked my question some time ago. Is it a pure weekly wage, being the award wage? Is it to include overtime, attendance bonuses or bonuses paid at the end of the year? Is it to include child endowment? The Minister says that most certainly this will not include child endowment. How is it to be determined? If the Government says that it will be determined on the previous 12 months earnings, that will not work because the worker will increase his weekly earnings by a decision of the court, by the generosity of the employer, by overtime or by something of that nature. Consequently it is not easy to say that the figure is $42.50. In these changing times workers will press for higher wages by on-the-job methods or through the arbitration system. Consequently it appears to me that the figure will have to be reassessed continually. I would appreciate if the Minister could give some indication of what machinery will be used to determine that $42.50 or the gross of $48.50 to which she referred in her second reading speech.
I would appreciate- if the Minister would indicate to the Senate whether the Queensland Government is to receive the full entitlement of $2 a day for each bed occupied in lieu of the 80c a day it receives now. It appears to me that the Bill does indicate thar it will. Nevertheless, in my humble opinion, it does not say so precisely. Therefore, I would appreciate if the Minister could indicate the situation in regard to that matter.
– I rise to indicate briefly what I have indicated already to the leaders of the parties regarding the 2 amendments. I hope not to stray as far from the Bill as some of the previous speakers did. We had all kinds of talks about off-shore legislation, estate duty, and the things that might have been in the Bill but are not. We have had suggestions about things that the Australian Labor Party would like to have in the Bill but which we have never suggested. I do not think that gets us very far, although it might be very good politics over the air. I remind the Senate of the amendment of the Australian Labor Party. We have sought to add certain words to the end of the motion. The motion is:
That the Bill be now read a second time.
We have sought to add: but the Senate is of the opinion that, while the Bill represents some improvement, a National Health Insurance Commission financed from graduated contributions would pay for medical and hospital services for all more equitably and economically.
I do not want to go into all the arguments, but I want to point out one or two salient facts. Operating in Australia today in the collection of funds and paying out of funds under the medical scheme are 117 funds in action all at once. Surely honourable senators would agree, without referring to the report of the Commonwealth Committee of Enquiry into Health Insurance - the Nimmo Committee report - that it is selfevident that there is a pretty wasteful gathering and distributing of funds under this scheme. This was very trenchantly criticised in the Nimmo Report.
What the Australian Labor Party scheme would mean, as we have stated briefly tonight, is the substitution for the 117 funds of 1 fund which would be the Taxation Branch. There would be immense savings and much more efficiency in paying out these funds. I have not heard any arguments against that proposition. I did hear Senator Greenwood condemn everything that he said was compulsory. 1 did not hear him make any analyses - and he wandered pretty far from the Bill - as to why he did not complain that child endowment is paid out of compulsory levies through the Taxation Branch. Pensions also come from a compulsory levy paid through the Taxation Branch. Indeed a very large part of health costs are paid out of taxation moneys. Insurance has to be compulsory if any kind of governmental assistance is to be given and the Government always takes a very over-simplified approach to this matter and says that the money that is paid in contributions to this compulsory insurance is the sum total of what is paid in. Of course this is not so. This is only a part of it. The medical costs of Australia today are being paid partly out of taxation, which is compulsory, and partly out of the rest of the scheme, which is compulsory if one wants to come under any part of the Government scheme.
I do not think Senator Greenwood’s arguments hold very much water when they are closely examined. One of the things which bothers the Australian Labor Party tremendously is that under this scheme the person least able to afford the payments has to pay the most. This is illustrated simply by taking 2 people living side by side and both paying $100 a year for the protection of their family and themselves. One man is paying 60c in the dollar taxation and the other man is paying 20c. At the end of the year the Commonwealth Government says to the comparatively wealthy man or the man who has the higher income: Well, to you, of that $100, we will remit $60 by way of a concessional taxation deduction’. To the man who is paying 20c in the dollar because he is on a smaller income the Government says: ‘To you we will give back only $20 out of your $100’. The net result is that the man on the higher income is paying a total of $40 for his cover and the man on the lower income is paying a total of $80. Of course, if a man pays 10c in the dollar in tax, he gets only $10 back.
How can a scheme like this be justified in this area in which the Government says it is trying to help those people who are less fortunate. This Bill does this to some degree depending on the different angles from which you approach it. These are the reasons why the Australian Labor Party says in its amendment that benefits would be more equitably distributed amongst the people of Australia by introducing the type of scheme which the Australian Labor Party has put forward. This great emphasis on compulsion which we heard from Senator Greenwood tonight is already inherent in the whole of our taxation system and the whole field of social services.
– You have compulsory third party insurance.
– As Senator McClelland indicates one can go on ad infinitum. I do not want to go into the whole details of the Bill. Today Senator McClelland demonstrated a very broad proposition. He laid a very good ground for the debate. He did a thorough job of research on this and he presented the views of the Australian Labor Party on this amending Bill very succinctly and clearly. The Australian Democratic Labor Party proposed an amendment which has 3 paragraphs. By the amendment the Senate is asked to take this legislation out of this House, to delay it while the Australian Medical Association has a conference. Senator Byrne seemed very confident that there would be a delay of only 12 days. I do not know how he can be so confident of this. If we place the decision on what we are talking about tonight in the hands of an outside body - however illustrious that outside body may be - and ask it to decide, it would not know what its conference would do. The matter could be adjourned, or it could be given to a subcommittee to report back to the conference. All honourable senators have been at conferences. We never know at the beginning of a conference exactly how much time is available or what particular item is going to come out at the end of the 3 days or me week or the fortnight or whatever time we allocate. Time and time again these things are delayed.
The Democratic Labor Party is suggesting that this Parliament should adjourn this Bill and wait at the behest of a conference to say when it shall go on with the legislation. To be fair to Senator Byrne, he said that the Senate could fix some time limits, if honourable senators revert to the amendment which was moved by Senator McClelland they will note that the Australian Labor Party says that the Bill represents some improvement - and it does. This improvement was indicated in October last year, lt was mentioned again more clearly by the Minister for Health (Dr Forbes) in March this year. It is now the end of May and the benefits contained in the Bill would cover, without any payment, the person who at the time of the legislation last year, was on the minimum wage of $39 a week. But that is now being increased to $45.50 because of the inflationary trend in wages which we have grown accustomed to living with. That amount has now become the minimum wage. At the time that legislation was introduced I thought it would have been an excellent idea if it had been written into the legislation that the amount could move as wages moved. One is going to be faced with increased wages from time to time. As 1 say, this was promised in October and it was indicated again in March of this year. The Australian Labor Party does not see any reason why these very needy people - the most needy people in the community - should be delayed 1 day longer.
– There is no assurance that they will consider the patient.
– As Senator Wilkinson said, these are the promises that are made. He is only in line with what 1 say. When we put this legislation in the hands of the conference we do not know what the discussion is going to be. We do not know how long the conference is going to sit. We do not know what the fate of their decisions or considerations will be. The matter could easily be adjourned. It could easily be handed to subcommittees. The
Parliament could be in a position where its last position could probably be very much worse than its first position.
As I understand it, there has been some communication between the doctors and the Minister for Health over a fairly long period of time. This is the responsibility of the Government. This is why in the second reading debate the Australian Labor Party has not gone into far more detail, as some of its speakers have indicated they would like. The Australian Labor Party has not done that because, rest assured Mr Deputy President, if we were the Government of this country bringing down a bill tonight it would be a vastly different bill from the one being brought down by the Government. That is why in the second reading stage the Australian Labor Party has stated the broad principle on which it believes a medical scheme in this country ought to be run. Senator McClelland has a lot of complicated amendments. I do not envy him his job tomorrow when I think the Senate will be considering them. I think it is desirable that the Senate consider these amendments tomorrow because the Bill was introduced yesterday and the Government requested that the Senate debate the Bill today, lt was quite a complicated job looking at the amendments that had been agreed to firstly by the Australian Labor Party in caucus and then taken to the House of Representatives. Because of the more restrictive standing orders in the other place in regard to moving amendments, some amendments were ruled out of order and others were guillotined completely out of court. They were never considered. All these had to be closely checked. We had the clerks doing an excellent job with us.
It is true, as the Democratic Labor Party and Senator Turnbull pointed out, that these amendments did not come here until fairly late in the evening. But let me assure honourable senators that there were no dilatory tactics on anybody’s part. We were working on the amendments all day. I think it would be quite right to defer discussion of these amendments until tomorrow.
– Do you concede that we have a case?
– I agree completely that it was nobody’s fault. The Bill had to be discussed today. Because of the pressure under which this Parliament has been working delay was unavoidable. The honourable senator has raised the point, f concede immediately that the Senate should not go on with the Committee stage tonight. It should be postponed until tomorrow. But 1 want to get back to the point of the two approaches which the Australian Labor Party has made, lt has stated the broad principle in the second reading speech and what is proposed in the Committee stage. 1 emphasise that this is noi the sort of Bill which we would want to amend. If we were the Government it would be a vastly different kettle of fish. Nevertheless we believe this legislation can be improved. 1 believe there are things which ought to be staled. 1 hope that the Committee of the whole - the Liberal Party of Australia, the Australian Country Party, the Australian Democratic Labor Party and the independent senator - will look at these amendments with a completely objective view to see whether this Bill cannot be amended further and improved. Those are the reasons why the Australian Labor Party does nol support the amendment moved by the Democratic Labor Parly. The Australian Labor Party does not want to make a great issue out of it. As Senator Byrne indicated the Democratic Labor Party proposed its amendment in good faith. We do not believe this is the best way to handle this. Because of this the Australian Labor Party will not support the further delay in bringing forward the benefits in this Bill. I. have pointed out these benefits. 1 emphasise again that they strike at the very people in the community whom we all want to help; that is those people who are on the minimum wage today, lt is a great disgrace to our wage structure that the minimum wage is $43.50. I have never quite worked out how people live on it, but at least the Government is doing something in that field. We acknowledge that and we do not want to see the Bill delayed, so I suggest to the Senate that it reject the amendment which has been moved by the Democratic Labor Party and write in the general principle by supporting our amendment. If the Senate does not do this tonight some day in the future, whether it be near or far. the principle will be adopted by the Australian Parliament.
[10.51] I rise to speak in reply to a number of points which have been raised during the debate tonight. We all appreciate that this is a very important piece of legislation. I believe it is a very important occasion when we debate it in this chamber for this legislation is to carry out the promise made by the Prime Minister (Mr Gorton) in his policy speech before the last election. It is also important, as we have all recognised, because it is to benefit people who have financial problems during illness, lt is very important that they should be given the very greatest assistance that we can give. This, of course, bears out the point which Government senators have stressed and which the Minister in another place has stressed, namely, the importance of getting this legislation through so that it can commence operation as soon as possible. r would like, first of all, to speak to the amendment moved by Senator McClelland and I wish to inform the Senate that I reject that amendment. It is, 1 believe, based on a substitution of the Opposition’s health plan for that of the Government which this Bill so adequately expands. [ do not want to go into detail on the health scheme that the Opposition favours but wish to direct my comments to one aspect of the scheme which Senator McClelland supports. This is the claim that the scheme could be financed by a 14% levy on taxable incomes plus a Commonwealth subsidy which would replace the Commonwealth benefit component of the Government’s scheme. Despite statements to the contrary, 1 do not believe that the Opposition’s scheme could bc financed from this 1.4% levy which, incidentally, equates to an 8% increase in the level of income tax because the essential cost control factors in the scheme worked out by the original architects, Deeble and Scotton, who are well known university economic researchers, were removed by the Opposition to make it appear publicly more popular. Perhaps the original scheme could have been financed by the so-called 14% levy but without, the controls proposed by those who were the architects of it, such as the disincentives against small claims, it would not work. The limit on the amount to be levied of $100 for each taxpayer was altered by the Opposition, as honourable senators will recall, to $100 for both man and wife when both were working. 1 do not think there is any doubt that it would cost much more to finance than the Opposition would have us believe. I want to make it quite clear that the Government opposes the amendment moved by Senator McClelland.
I will speak a Utile later concerning the amendment which has been moved by the Democratic Labor Party but before I get on to that 1 want to refer to some individual points which were raised by honourable senators. In his opening remarks Senator McClelland referred to the fact that payments by registered health insurance organisations meet only 13% of the total cost of health services in Australia of $1,1 00m per annum. I believe that this
Statement gives a very distorted picture of the role of the registered organisations and the Commonwealth in the financing of health services. Voluntary insurance only attempts to cover the provision of care in approved hospitals and medical treatment by doctors, as would also be the case with the Labor Party’s scheme. When these two aspects of total health care - which, it must be remembered, cover among other things medicine and public health services - are looked at it is found that the fund benefits meet some 38% of the fees charged for treatment in approved hospitals while the Commonwealth meets a further 38%. With regard to medical treatment, fund benefits meet 26% and the Commonwealth 37%. Thus the health scheme meets some 76% of patients’ fees in approved hospitals and 63% of the cost of medical treatment by doctors. Overall the percentage is 69%.
Senator Mulvihill referred to one or two matters and I said I would get him the information concerning them as he requested. One referred to the entry in the annual report of the Hospitals Contribution Fund of Australia which shows an item of $500,000 as a loan. He asked what were the details of this loan transaction and also what was the rate of interest prevailing. The Hospitals Contribution Fund o’f Australia has furnished the following details of the public hospital loan of $500,000 shown in the balance sheet for 30th June 1969: The Benevolent Society of New South Wales in respect of the Hospital for Women, Paddington, New South Wales, $294,000; St Vincent’s Hospital, Lismore, $106,000 and the Mater Misericordiae Hospital, Waratah, $100,000. The loans are in accordance with section 37 of the New South Wales Public Hospitals Act 1929, as amended, and are for a period of 15 years from 8th January 1969. They are repayable by equal instalments of principal and interest on a halfyearly basis. The interest rate is 51%.
This also brings to mind a question which was asked by Senator Milliner which is question No. 86 on the notice paper. He asked if I could get an answer for this straightaway. He placed me in a difficult situation because of the rules of the Senate. As it happens, he will be receiving an answer to “that question tomorrow. It has already been received by my office from the Minister for Health (Dr Forbes) but I think it would be irregular for me to give it in reply in this debate as it is a question on notice. It is in the pipeline to be given to him tomorrow at the appropriate time so I know that he will receive the answer then. We have only 1 or 2 minutes left before the Senate adjourns and there are still a number of questions which I must answer. I want to speak much more fully to the amendment moved by the Democratic Labor Party but in these last 2 minutes I want to stress that I believe that in this Bill we have legislation which is of the utmost benefit to the people of Australia, legislation which is carrying out one more promise made by the Prime Minister during the last election campaign. I believe it is tremendously important that we ensure that there is no delay in this legislation because the sooner it is in operation the sooner it will confer benefits on people which every one of us is most anxious they should receive. Therefore I cannot stress strongly enough the importance of this legislation not being delayed so that we may continue tomorrow with the matters which will be before us and 1 will reply in considerable detail to a number of questions which have been asked. I shall give full reasons why I oppose the amendment of the Democratic Labor Party and I have some very detailed points which I want to make because I think it is important that the whole Senate should know them. But I do assure the Senate that I want it to give the speedy passage of this legislation very real consideration because it is important that it is passed without delay so that the benefits may be made available. I ask for leave to continue my remarks.
Leave granted; debate adjourned.
– Order! In conformity with the sessional order relating to the adjournment of the Senate, I formally put the question:
That the Senate do now adjourn.
Question resolved in the affirmative.
Senate adjourned at 11 p.m.
Cite as: Australia, Senate, Debates, 20 May 1970, viewed 22 October 2017, <http://historichansard.net/senate/1970/19700520_senate_27_s44/>.