Wilson Tuckey (O'Connor, Liberal Party) Share this | Hansard source

Thank you for your consideration, Mr Deputy Speaker Adams, in the matter of my late arrival. I did anticipate that the previous speaker would speak a little longer considering how proud the Labor Party is of this particular initiative. I have come really to talk about why a bill relating to money is not the solution in itself as to how to better administer health for the Australian people. Politicians, per se, have a habit of measuring excellence by expenditure. It does not work, and it works least in the delivery of public health services. The member for North Sydney has already quoted some of the amounts that are being made available under these appropriation bills and they are testament to the belief—and I think the general public has the same belief and I am not suggesting that the coalition has any plans to significantly change it—that government is best able to guarantee services to people. In other words, to give the service that people desire and to which they are entitled we believe that we have to own the shop.

What do we do next? We stand up in here and introduce an appropriation bill, and we talk billions of dollars for this and hundreds of millions of dollars for that. But, because of the nature of our federation and because of the attitude, I might add, here in Canberra where people are more anxious to send the money than ask what has happened to it, we shunt this money off to the constitutional managers of health—the providers of health services at the public level—and we think we have done the job. And what is the outcome of that? In the first instance, you have a circumstance where that money is divvied up by means of some formula and a major hospital—what was once known as a teaching hospital—gets a budget. Now, the first outcome of a budgeted hospital management is that patients are a liability. You have to be very careful that you do not have too many of them, if you are the finance controller. And, of course, you have to be terribly careful that they do not all want a hip joint replacement, because those are things that you have to buy and you have a limited number of them under budgetary management. So when you run out, that is just too bad. Then, of course, you have all the other matters that arise in the management of that sort of hospital.

I thank the two members opposite for listening to my speech. Maybe they will take some of these thoughts back to caucus. They would not have known Con Sciacca, who was a minister in the previous Keating government. I admired and was friendly with Con. He was the minister who, by his own initiative, instituted ‘Australia Remembers’. I happened to be the shadow minister in some respects copying him. I went around Australia congratulating him on that initiative because I thought the veterans deserved it.

But Con sold the repatriation hospitals, which were the property of the Commonwealth and managed by the Commonwealth. When we get onto privatisation, from time to time, if you like, you have got form. I endorsed that decision. But, having done so, the Labor New South Wales government and the Victorian Liberal government said, ‘We want them.’ So they took them over. You can check the history in Victoria; it became quite a mess. I think they sort of revolted. But in Western Australia and Queensland the state governments—again, I think, Liberal and Labor—said, ‘No, we don’t want them; sell them to the private sector.’

The Hollywood hospital in Western Australia, as it was known—the Hollywood Repatriation Hospital—was taken over by the Ramsay Health Care group. I can tell you the RSL were terribly concerned about this. They lived in this culture of ‘government needs to own the shop to guarantee us the service’, notwithstanding that at that stage there was a 10-month waiting list at the repat hospital for elective surgery for veterans. Anyway, I called in about three months later to see how things were going and they said: ‘Oh, it’s magnificent. We’ve gone from TV dinners to the reinstatement of the hospital kitchen, and the waiting lists are nearly all gone.’ And how was that achieved? They opened up the operating theatres on Saturday. How could Ramsay do this but a government funded instrumentality could not? In the process of the sale, they got an agreement that this parliament would pay them for services rendered. So, all of a sudden, a patient was not a liability; they were an asset. They took steps such as opening their operating theatres an extra day a week to in fact earn revenue by the process of looking after them—which, I would think, is the purpose of us allocating these huge amounts of money by way of appropriation: to give people service.

So what has happened? The only way that the general citizenry can benefit from that sort of incentive based process is to be in the private health insurance system. That is the only way. This is not policy either. In 1998 I happened to have the opportunity to write a policy about health and I did it on the basis that every Australian should be in the private health system and should be subsidised, according to their needs, for up to 100 per cent of the premium cost. That meant that, from there on in, everybody was in a system where they were welcome at a hospital. When I went around my own electorate—and I want to talk a little bit more about that in a moment—to the hospitals, which were run by hospital boards as government entities, and I explained to them how this would work, because a government hospital would still remain a government hospital but it would send the bill to MBF, Medibank Private, HCF, you name it, they all worked out that they would be better off financially just on the number of patients they handled at the time. But there was also an incentive to go back to introducing gynaecological services and so on, to encourage women to stay in that country town and have their babies. Some in the perimeter around Perth said, ‘When someone has an operation in one of the major city hospitals, where it is appropriate, after a couple of days they could send them out to us and we will go through their period of care.’ Now, all of that happened. As I go around my electorate now, most of those hospitals are closed.

During the time that was my area of responsibility, I went to a big conference where the keynote speaker was a ‘Lady’, an aristocrat—dame whatever—who had got that order for her services to the public health system. During her presentation, she said: ‘Waiting lists are a formal component of delivering public health services. We have to have them to manage our budget.’ She then went on to complain about the administration of waiting lists and how—and we may all be guilty of this—if you have got the right sort of member of parliament and they kick up enough fuss, you get pushed up the waiting list. I will not name names, but the wife of a very, very important member of the Labor Party, at the time resident in this town in a salubrious dwelling provided by the taxpayer, got gallstones. He was not, philosophically, privately insured. But where did his wife go? She went to Calvary Hospital, to a private room. The surgeon who operated on her was—surprise, surprise—a private surgeon, but she was told what day of the week he would be operating. Now, that is okay; that is the system. But that was this lady’s complaint. It was pretty interesting, because she was right: if you are going to have a public health system and you are going to have waiting lists, nobody should be able to get kicked up the list other than because of an emergency.

So it is not a very nice system. Of course, if you are privately insured, your doctor, having decided you need some form of elective surgery, picks up the phone and says, ‘Hang on a minute; I’ll get you booked in for next Wednesday.’ And it happens.

Not everybody can afford private health insurance and, to assist people in the community who had that desire, our government eventually picked up part of my proposal. I feel they picked up quite a few aspects of it over time in an ad hoc way, which I was not that pleased about because I thought the package was better. We decided that, where people were prepared to invest a significant amount of their own money in a private health insurance policy, we would subsidise their premiums to 30 per cent—that was for all comers—and then to 35 per cent for those over 65, I think the figure goes, and to 40 per cent for those over 70.

One of the things I also found in putting together my proposal was the actuarial advice as to where the demand for health services is most obvious. I do not have to tell anyone that. We proposed a three-tier premium system. Of course, people under 18 or 19 cost the system less than any other group, people in the middle cost more, and those people over 65 cost three times as much as others. That is another problem. When you have competing systems—that is, Medicare and private health—and the fact that ill heath or the need for medical services and hospital services increases with age, people will always have the habit of saying: ‘Medicare will do. If I get hit by a bus or have a premature heart attack, Medicare will look after me in a reasonable way.’

I still limp because I forgot to tell anyone after I had a very serious car accident that I was privately insured. I found I was being practised on by interns, registrars and others and I ended up coming out of hospital with a leg that was very bent. Then I remembered I had private insurance—I was not too coherent at the beginning of all of that—and I arranged for private health insurance to straighten my leg out. That is okay, but the fact of life is that when you are privately insured, you get a service of the level you desire. But we also provided subsidies.

What I am coming to is that, in legislation forthcoming but consistent with the funding package, we are seeing a relaxation of the pressure to join private health which is put on people through the tax system. That is an open invitation to many of them to walk away from the private health system. I was here during the Hawke-Keating government and I watched that happening. I believe there was a simple conspiracy to make sure that the private health system was put out of business. Please remember—for those who bother to read our Constitution—that the civil conscription of doctors, dentists and such people is forbidden under our Constitution. As a government, you cannot implement British national health because you cannot conscript the people you need to run the shop. But, of course, if you send the private health system broke, there is no choice and, if you have a penchant for a British national health system, you achieve it by default.

What I saw, particularly in the Keating years—and not particularly because of him; the matter was just getting into a massive situation—was that the membership of private health was collapsing exponentially. Every time another group of limited claimers or nonclaimers left, the premiums went up substantially and as a result of that another group of the less demanding left—the ones who balance the book, if you like, in the bookmaking of insurance, and that is all it is—and then the premiums escalated even further. Of course when the Howard government came to office, private health insurance was about to fall over. I have said, had Keating won one more election, that would have been the end of the private health system because there just would not have been enough people left. You would have to be super rich to have stayed in and paid the full premium cost.

Now there is another aspect of insuring people for health, and that is the increase in the state of technology. The solution once for bad knees, bad hips and other such complaints was to buy a wheelchair. The technology was not there to repair your hip and your knees as it is today. That is occurring across the board and, as a result of that, the cost of delivering health services will always rise much more rapidly than inflation or whatever else you want to talk about. As a member of this parliament, I am willing to endorse taxes necessary to see people have that service.

What I hate is to see speeches like this one which says we will achieve excellence by expenditure. State governments, no matter what political persuasion, will never have enough money to do the job. In Western Australia we have been promised a new hospital—the Fiona Stanley Hospital. If I were that lady of great importance, an Australian of the Year, I would say, ‘For God’s sake, take my name off it; I’m getting embarrassed.’ It is still not operational. Furthermore, the other day the government did not even put up reasonable financial support for the Royal Flying Doctor Service. They still think it is a charity when, every time they close a hospital in some country area, they call on the RFDS to be the taxi service to bring those people from much depleted facilities into a major hospital, typically in the metropolitan area or maybe in a large regional area. For shorter distances you have volunteers, connected to the St John’s Ambulance charity in my state, having to do the same thing. People who are only reasonably ill have to be driven to the metropolitan area because there are no amenities left in the country and that has happened in the last 10 or 15 years. So what has happened to the money that has been sent there? Does the system deserve the support that we impose on the taxpayer, or should we be looking to a payment for service system, whether it is applicable to a public hospital or a private hospital? Should we be genuinely trying to get rid of waiting lists, which every senior hospital administrator will tell you are a part of their budget control system?

I refer you to that lady from New Zealand who got it right. She was happy to have waiting lists but she was very cranky about those who could step up the list, including a very important person who sat in this parliament for a long time. It should not work that way, but that is what communism was all about. I remember talking to a communist MP who said: ‘I knew as a young man how to get ahead in Russia. I had to join the Communist Party, because then I got privilege.’ We should not have that in Australia. As I say, this is a genuine attempt to make some of the newer members who attend caucus ask, ‘Is there a better way?’ It is not that we should not allocate the money, but we should do it better.

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