Health Care and the Common Good
This article first appeared in the February 2002 New Citizen.
High quality health care is a universal right, which is inherent in the notion of the "common good", the purpose for which nation-states were founded. The commitment to the common good was the underlying philosophy of the old Labor Party in Australia, as stated by one of its founders, Australia's greatest trade union organiser, William Guthrie Spence:
"The welfare of the people must be raised to the first place—must be the uppermost and foremost consideration. How best to secure the good of all without injury to any should be the aim—not commercial supremacy, not cheap production regardless of the human misery following, but rather the broadest justice, the widest extension of human happiness, and the attainment of the highest intellectual and moral standard of civilised nations should be our aim."
This "welfare of the people" for old Labor self-evidently included quality health care for all. One of the first acts of a Federal Labor government around 1910 was the introduction of the invalid pension scheme, coupled with the old age pension program. At the same time, the Minister of Health of NSW's Labor government, Fred Flowers, told the Sydney Morning Herald of March 11, 1911, "Any ideas that the hospitals are to be regarded as charitable institutions is altogether erroneous. Hospitals are a necessity of civilisation and the government should see to their upkeep and control. Hospitals should be as free as the Art Gallery and Public Library … and there should be no taint of pauperism."
It was with the election of John Curtin as Labor Prime Minister in 1941, though, that progress was made towards a national system of universal health care. Curtin was committed to a national health service which, like education, would be free to all members of the community. Faced with opposition from the conservative parties and the medical profession, he called and won a referendum in order to obtain the necessary powers over social welfare matters—one of the few times a referendum has been successful in this country. This referendum later gave the Whitlam Labor Government in 1974 the power to finally introduce a truly national universal health scheme, Medibank.
Although Curtin's referendum was successful, progress was slow. In 1945, after Ben Chifley became Prime Minister, the federal government passed the Commonwealth Hospital Benefits Act and began funding the states for each patient occupying a bed in a public or private hospital. In 1948, Chifley introduced a comprehensive National Health Act, which he described as "a charter of national health for the future." The legislation envisaged the possible nationalisation of hospitals, along with government provision of laboratories, health centres and clinics, as well as a Medical Benefit Scheme under which the Government would pay direct to doctors one half of the patients' medical fees, subject to fee limitation by participating doctors. Before it could pass the bill, Chifley's government fell.
Labor had greater success in Queensland, when in 1944, the state government took complete control over the hospitals, the public health and mental health, and became the first and only state to provide completely free, government funded universal health care.
In the twenty-three years of Liberal/Country Party federal government which followed Chifley, despite a general shift away from Government funding, some progress in health care was still made, particularly under Minister of Health and Country Party leader Sir Earle Page, a surgeon-turned-politician. He introduced the free school milk scheme to improve nutrition, as well as a Pensioner Medical Service which gave aged, invalid, widows and service pensioners and their dependents free medical treatment by a general practitioner. The Coalition also passed the Aged Persons' Homes Act in 1954 to expand aged care. Within less than a decade there were 2.3 nursing home beds per 1000 of population, and by 1971 there were 3.7 per 1000, giving Australia the greatest number of nursing home beds per head of population in the world. In addition the anti-polio vaccine first trialed in America was being locally produced in Australia by the end of 1955 and supplied to the States free of charge for a nation-wide vaccination program. Australia also had one of the highest ratios of public hospital beds per 1000 population in the world (6.5 as of 1980), higher even than the United States, whose postwar Hill-Burton Act mandated a ratio of at least 5.0 to 1000.
The last effort by government to uphold the old Labor ideal of health care as an inalienable part of the "common good", however, came and went with Gough Whitlam (1972-1975). One of Whitlam's most controversial policies, second only to his determination to "buy back the farm", was his plan to introduce Medibank, the first truly universal health care system. This legislation was cited as one of the grounds for the double dissolution of Parliament on April 10, 1974.
Medibank was anathema to the free-traders. It eliminated the means test for hospital treatment and provided standard ward accommodation for free; provided free outpatient treatment; provided salaries for all doctors providing care to public patients (ending the earlier honorary system, where doctors received fees from private patients, and donated their services to the public system); and covered 85% of all medical bills by the government, with the 15% balance insurable. Fees were collected either by bulk billing (the preferred option), or the patient paid the doctor and then collected 85% of the fee from the Medibank offices.
The Medibank legislation was eventually passed in August 1974 after Labor's reelection, but barely had time to become operational before Whitlam was dumped by the Crown, through Governor-General Sir John Kerr, on November 11, 1975.
Under the next government, headed up by Malcolm Fraser, health policy was dictated by economic considerations and a desire to shift health expenditure back to the private sector. Fraser's Jamison Inquiry into "hospital efficiency" helped to introduce the use of "business methods" in the health care industry. Under economic rationalists Hawke and Keating, it soon got much worse.
