SPEECH BY THE PRIME MINISTER
THE HON. E. G. WHITLAM, M. P.,
TO THE FEDERAL CONFERENCE OF THE HEALTH AND
RESEARCH EMPLOYEES' ASSOCIATION OF AUSTRALIA
SYDNEY, MONDAY 3 MARCH 1975
It is seven years since I had the pleasure
of opening an annual conference of your association.
It was a memorable conference and a memorable year for
my party. It was in 1968 that Labor formulated its
health scheme. In my speech on that occasion I took
one of the first opportunities available to me to
explain publicly the fundamentals of our health program
and the philosophy behind it.
Since then I have often had cause to be
grateful to your association for the support you have
given us support through two elections, continuing
support for one of the fundamentals of Labor's program.
Experience has taught me to be grateful for the fact
that medical care is not solely in the hands of the
medical profession. Health is too serious a matter
to be left to doctors! Your association is one of the
oldest and largest trade unions in Australia. Your
members include a wide range of workers in public, and
private hospitals, in psychiatric hospitals, child
welfare institutions, ambulance services, universities
and laboratories. No one is better qualified by dayto-
day experience to understand Australia's health
problems, why they exist and how they may be resolved.
You know at first hand the shortcomings and inadequacies
of our hospitals, the lack of equipment and facilities,
the problems of staffing and morale. You have seen the
failings of the antiquated and inefficient private
health insurence scheme. At the same time you have
been in the vanguard of many important industrial
reforms. That is why I value so highly the support
you have given the Government support expressed in
successive conference resolutions. ./ 2
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Anyone who heard my speech to you seven years
ago will be forgiven for thinking that the more things
change, the more things ~ remain the same. For the truly
remarkable thing, the sobering thing, is that so much
of what I said to you in 1968 the facts, the figures,
the arguments of 1968 are still part of the current
debate about health care in this country. The Labor
health scheme, the scheme developed and nurtured in
those days, has of course been modified over the years,
but its essential purpose remains the same. We are
determined to bring universal health insurance to every
Australian. We are determined to ensure that every
citizen, regardless of means, enjoys the best medical
and hospital care that an affluent and advanced society
can provide. It is one thing, of course, to grant universal
health insurance coverage. It is another to see that
those benefits give real security against the cost of
hospital and medical care and that the price of this
guarantee can be met by the community. Labor's scheme
means that for the first time the whole community will
be undertaking responsibility for the community's healthjust
as the community is responsible for the education
of chiLldren. It is a sad and astonishing fact that
Australians can still be brought to court, and even put
in gaol, because of an * inability to pay medical and
hospital bills. It is a sad and astonishing fact that
more than a million Australians have no protection
against medical or hospital expenses. And the people
who remain outside the present system are precisely
those most in need of health insurance coverage.
It is certainly not for want of trying that
seven years after it was first proposed, Labor's health
scheme has still to be implemented. Never in the history
of our country has a major social reform faced such
sustained and unscrupulous opposition. our proposals
have been debated interminably. No policy has been more
thoroughly expounded or widely canvassed. Our health
program was adopted at the ALP Federal Conference in
1969. It was first put to the people at the 1969 general
election and was in fact the central issue in that
campaign. It received a clear mandate from the people
in the 1972 elections and again in the 1974 elections.
So the people have three times voted for it, twice
approved it, twice empowered us to put it into action.
The basic legislation has been passed three times by
the House of Representatives. It was one of the bills
that formed the basis of the double dissolution. It
was passed a fourth time at the joint sitting of both
Houses last August. It has had repeated electoral and
legislative endorsement. If ever a party had a mandate
for its legislation, the Labor Party has a mandate for
its health scheme. / 3
w
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There is something about universal health
schemes that arouses a special fury in the hearts of
conservatives. In every western country social democratic
parties have had bitter and protracted struggles to
implement similar proposals. The British national
health service a scheme very different from ours, a
scheme, nevertheless, much maligned and much misunderstood
has been so widely accepted that no Conservative
Government has dared to undo it. You will remember
the efforts of doctors and conservative politicians
in the United States to sabotage the Medicare scheme.
Similar battles have been fought in Canada and New
Zealand. All these schemes have differed in points of
detail, sometimes quite radically, but all of them have
had one basic purpose to make medical treatment
available to all who need it, to ensure that medical
care is not just another marketable commodity but a
right of every citizen.
Of course it is not just doctors who oppose
the health scheme. If we only had the doctors to contend
with our scheme would have been working long ago. In
fact there are thousands of responsible and fair-minded
doctors who support us. The truth is that our health
scheme arouses the deepest conservative instincts in
our political opponents our opponents in the Parliament
and our opponents in the community. The issues involved
are quite fundamental to the basic political struggle.
That struggle is between those who want greater equality
and those who want to preserve the power and privilege
of a minority. It is perfectly obvious that doctors will not
be a whit worse off under the Labor scheme than they
are at present. I am sure the doctors know this in
their hearts. Their incomes will not suffer; indeed
they will rise. Their practices, their day-to-day routines,
will not change. All that will change from the doctors'
point of view is the method of settling accounts. For
many doctors this process will be more prompt, more
simple and more reliable. I regret to say that doctors
have been the victims of their own scare tactics and
irrational prejudice. After next July, when Medibank
is in operation, they will come to see that their fears
were groundless. They will see that they were hoodwinked
by a minority of extremists and propagandists in the
profession and in the Parliament. I am dismayed at the
lengths to which this great profession has gone to
frustrate the wishes of the Australian people. There
has never been a time when doctors were more at odds
with popular opinion, more insensitive to the community's
needs, or more indifferent to self-inflicted wounds on
their professional reputation.
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Misguided as their opposition has been, the
obstruction of the opposition has been even more disgraceful,
their obstinacy on this matter, their utter
contempt for the expressed wishes of the people, have
been staggering. Even when the health bills were passed
at the joint sitting, they proceeded to block our ancillary
legislation to give effect to the Government's measures.
This obliged us to make substantial changes in the method
of financing the scheme.
Even now, with plans for Medibank well advanced,
the Opposition is still threatening and undermining
and misrepresenting our proposals. Mr Snedden last
week told a public meeting in Melbourne that the Liberals
would dismantle Medibank and pull down Labor's plans
for national superannuation and a national compensation
and rehabilitation scheme. These are all programs to
which your association has pledged support. They are
all programs for which the Government has a mandate
from the Australian people. We cannot ignore these
threats. Australians have already seen how a right-wing
Federal Government can destroy a free hospital system.
You will remember that every Australian had free standard
ward hospital treatment for five years in the late
and early ' 50s under an agreement between the States
and the postwar Federal Labor Government. The Menzies
Government broke off that agreement. By June 1953 most
State Governments had re-introduced charges for public
ward patients. Australia's first free hospital scheme
was dismantled. So don't think it cannot happen with
Medibank. It has happened once, and the Liberals would
do it again. Our opponents were never able to decide what
their attitude to the old health scheme should be. They
argued in one breath that no change was needed and in
the next breath that the present scheme can be easily
repaired. When I last spoke to you I drew attention to
some of the central weaknesses of the voluntary scheme.
The Liberals had years to correct the shortcomings of
the private insurance system. They did nothing. Nearly
all the criticisms I made in 1968 can still be made of
the private insurance scheme. It is costly. It is
riddled with duplication and wasteful competition. It
ignores the needs of a million or more Australians who
have no medical or hospital cover. Contributors are
obliged to pay a substantial proportion of the cost of
the health services they receive. The scheme is illequipped
to take account of increases in fee scales.
It imposes unnecessary hardship on pensioners.
Many of these weaknesses were exposed in
the report of the Nimmo Committee in 1969. Nimmo
proposed many reforms to the old scheme. For example,
they suggested voluntary deductions by employers to
achieve a wider voluntary cover. They proposed a
national Health Insurance Commission and standard ward
hospital care without a means test. The Liberals did
none of these things, but all of them have been incorporated,
in various forms, into the Government's present
proposals. And here we find a particularly striking
example of Opposition obstruction and hypocrisy. Early
in 1968 the Senate set up a committee to look into
hospital and medical charges. Mr Justice Nirrmo' s
committee, to which I have referred, was established
by the Liberal Government partly as a counter to the
Senate committee. I do not disparage either of these
inquiries; they did valuable work. But it was clear
that the previous Government was prepared to ignore
both committees when their findings didn't suit them.
Last December the Senate removed important provisions
from our health legislation relating to the supervision
of health insurance organisations. These provisions
were essential to protect the rights of contributors.
We accepted the Senate's amendments last year
because, had we not done so, other important provisions
of the legislation would have been held up. Last week,
however, the Minister for Social Security, Bill Hayden,
brought in new legislation to cover the provisions
deleted by the Senate. The point is that the Senate's
action last December was directly counter to the
recommendations of both the Nimmo and the Senate's own
committee established in 1968. It was counter to an
undertaking given by Dr Forbes when he was Liberal
Minister for Health. Dr Forbes promised on 4 March 1970
that he would implement the Nimmo recommendations
relating to health fund reserves and the establishment
of a special stabilisation account. In other words
the Senate was ignoring the recommendations of its
own committee and the promises of a Liberal Minister
in obstructing our legislation.
The development of social welfare policy
invariably calls for compromise and flexibility. It
has never been our approach to strike dogmatic attitudes
or to ignore criticism. I believe Bill Hayden's
handling of the Medibank negotiations was a model of
firmness and fair play. To listen to our opponents
you would think we had forced through every detail of
our original scheme and done nothing to accommodate
reasonable suggestions from doctors or interested groups.
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6
It is worth looking at some of the modifications
we have made in evolving the final shape of the
Medibank scheme. I don't regard these concessions as
any sort of weakness or backtracting since none of them
undermines the essential structure of our plan. Indeed
I acknowledge that many of the suggestions we have
incorporated will do much to widen and strengthen the
scheme. For example, we have decided to allow people
who want additional private health insurance to insure
with private funds; we have agreed to provide full
benefits for medical services in private hospitals; we
have agreed to increase by 30 per cent to $ 16 a day
the bed subsidy payable to patients in private hospitals;
we have agreed to defer our measures to ensure that
doctors adhere to schedule fees and drop premium
payments designed to encourage doctors to bill the
Health Insurance Commission directly. All this was
done in a process of open public debate, in a spirit
of, co-operation and frankness. Yet the AMA and the
Opposition ignore these reforms and modifications. They
mouth slogans about " freedom of choice" and " nationalised
medicine". For those who still give credence to these
rantings I repeat categorically: We cannot nationalise
medicine and we have not attempted to do so. And every
Australian under Labor's scheme will have complete
freedom to go to any doctor he chooses.
There is one class of patient who will gain
particular benefit from the Medibank scheme. I refer
to pensioners. Currently Pensioner Medical Service
patients are entitled to free treatment only for GP
consultations. In future, pensioner patients will have
access to all medical practitioner treatment specialist
as well as general practitioner, procedural and diagnostic
as well as consultations. Under Medibank, all treatment
will be free to pensioner patients whose doctors agree
to bill Medibank directly that is, if their doctors
accept the medical benefits payable for a particular
service and do not charge pensioners an amount on top
of the benefits. For the rest of the community, as you
know, treatment will also be free if doctors bill Medibank
direct. They will not be bound to do so, and will be
free, if they wish, to bill patients in the traditional
way. In this case the patient will have to meet only
per cent of the schedule fee up a maximum amount
of We are offering the States a much better deal
for hospitals than they have now. We are ready to enter
into agreements with the State Governments to share
equally the net costs of operating State public hospital
systems. This will mean, as it did in the late
and early ' 50s, public ward treatment free of means test
and free of charge. For those choosing private treatment
either in a public or private hospital, there will be an
$ 18 a day subsidy towards hospital bed charges. It is
frankly difficult to imagine why any State Government
would refuse such a generous cost-sharing arrangement
and penalise its citizens so severely. It is obvious / 7
7
that hospital charges, which have already risen steeply,
will go higher if the present financing system continues.
We are building on existing and well-accepted
public hospital arrangements. The only innovation is
that honorary medical services ( those in public wards
for which no payment is made to the doctor) will be
eliminated. Doctors will be paid on a sessional or
other contract basis. After all doctors in Queensland
are already paid on this basis, and it is accepted by
the AMA in that State. It is moreover, an increasingly
common practice for many visiting specialists at public
hospitals in all States. So far only Tasmania and
Queensland have agreed to co-operate in our scheme. I
hope the other States will come to accept it for the
sake of their people. We owe it to ourselves and our
families to see that every State Government participates
in the new arrangements.
Medibank will mean substantial savings for
every Australian contributing to a health insurance
fund. I give examples of what contributors will save
in New South Wales. For medical insurance alone, $ 96.72
a year; for medical and public ward hospital insurance
$ 157.04 a year; for medical and intermediate ward
insurance $ 132.72; for medical and private ward insurance
$ 123.76. For all that, it would be a mistake to think
of Medibank merely in terms of money savings of extra
cash in the pocket. It represents a great commitment to
community well-being, a great experiment in social
responsibility, a milestone in the history of progressive
Labor legislation. When Medibank is in operation, when
people come to see and feel the practical benefits of
the scheme and the increased sense of social security
it fosters, there will no longer be any talk of pulling
it down. It will stand, like all great reformist measures,
as a permanent landmark in our legislative history. Its
success will owe much to the steadfast support it has
received inside and outside the Labor Party from social
welfare workers, from hospital workers, from enlightened
members of the medical profession, and not least from
the members of your association, whose annual conference
I now have pleasure in opening.