One Voice: Peace Breaks Out
Peace between the BMA and the Commonwealth was restored when the Chifley Government lost the 1949 election and was succeeded by a government led by Mr Menzies and including as Health Ministers over the next decade BMA members Drs Earle Page and Don Cameron.
The relationship between government and the association quickly became less bellicose. Consultations took over from salvos. These consultations could be fairly lively, according to BMA officials who were present. They found that Dr Page could be “explosive” – described by colleagues as a “controlled tornado” – compared to Senator Nick McKenna, his much calmer predecessor in the Chifley Government. He had inherited Senator McKenna’s advisers who, one BMA official has said, “were all very nice fellows, but unchangeable as the Bourbons”. Nevertheless, the contacts led, especially in the first few years, to private practice being retained on a fee-for-service basis and government subsidies for the health funds to help defray patients’ health and hospital costs, as the BMA had proposed in its “general principles” of 1941 and as Dr Page had promised in the 1949 election campaign. The BMA was invited to have representatives on the Pharmaceutical Benefits Advisory Committee and an enquiry into the Pensioner Medical Service.
With the BMA closely involved, the Government drew up the National Health Act, whose component parts were the PBS, the Pensioner Medical Scheme, the Medical Benefits Scheme and the Hospital Benefits Scheme, and whose structure and operation had (in the opinion of the BMA) been rendered simple, unobjectionable and compatible with private practice. Later, in the early 1960s, Health Minister Senator Wade set up a consultative committee, composed of BMA and government officials, to “simplify and speed up the settlement of matters of mutual concern” in the health system. Sir Cecil Colville, President of Federal Council (and later first President of the AMA), said that the committee “in no small measure contributes to the smooth running” of the health service.
Problems did arise from time to time, even in the era described by Sir Earle as one of cooperative partnership between the BMA, the Government and the health funds. There was still the odd disagreement: over the formulary lists and charges for prescriptions in the PBS, for example. The Government’s response to the BMA pointing out anomalies in medical benefit schedules was not considered to be very helpful. The Government rejected a BMA request for representation on the Commonwealth Insurance Council and the need for an adequately representative Medical Benefits Advisory Committee. Changes to the means test under the Pensioner Medical Scheme in 1953 had its effect on the incomes of private practitioners, which had caused some disquiet among members. But, essentially, the era of cooperation – with health no longer such an acute area of contention between doctors and government or a vexed campaign issue in five federal elections – had resulted in a relationship that was deemed to be working reasonably.
The AMA Annual Report for 1966 recorded “its appreciation of the willingness of successive Ministers of Health to discuss with Federal Council important matters associated with the National Health Service and with medical planning in general. It is hopeful that such a happy relationship with the Commonwealth Government may continue.” In the 1967 Annual Report, the AMA complimented the Government for the spirit of cooperation epitomised in “informal meetings, at which many problems are resolved before they grow into areas of conflict”. But this cooperation was becoming less friendly. By the end of the 1960s, and especially by the time John Gorton had succeeded Harold Holt, the relationship was coming under pressure, and it would lead to much dissension between the profession and the government and within the profession and its organisations.
Among the reasons for this was almost certainly the fact that, except for one brief year in 1963, none of the four Health Ministers had had Cabinet rank since Sir Earle Page had retired in 1956. So it can be argued that it was not all that high among the priorities of the later Menzies and successor governments. Harold Holt succeeded Sir Robert Menzies in 1966, John Gorton succeeded Harold Holt in 1968, William McMahon succeeded Gorton in 1971 and – in all that time, until the McMahon Government lost to the Whitlam Government in 1972 – Health remained a junior Ministry, though the health service itself was clearly showing wear and tear around the edges.