To the Editor: In his message From the Editor’s Desk,1 Van Der Weyden laments what he perceives to be “the absence of many voices in protest” against the current Council of Australian Governments’ (COAG) proposals2 for national systems of registration and accreditation of the Australian health workforce.

The absence of an “overwhelming public response” to the proposals can surely be attributed to the general public’s lack of awareness of the proposals. It cannot be said, however, that the medical profession has been idle.

By the time this letter is published, the situation in regard to the proposals is likely to be much clearer. To date, all elements of the medical profession have been very active in seeking to achieve the best possible outcomes from the COAG proposals for our patients and for the profession. These efforts were impeded initially by the lack of specificity available from the COAG Health Working Group.

Clear evidence of the effectiveness of the efforts of the Australian Medical Council, the Australian Medical Association, and the Committee of Presidents of Medical Colleges (CPMC) and its individual member Colleges was the abandonment of the second consultation paper after the profession’s analysis and evaluation of the proposals presented. As I write, government officials are meeting to develop a new model which recognises the profession’s criticisms and views.

The profession’s message clearly has reached the federal Minister for Health, who asserted recently that it appeared that “the best way forward is to have separate national registration boards for medicine and for each of the other health professions”.3 This is a significant departure from the original COAG proposal.

The CPMC and its member Colleges are well aware of the undesirable developments in other countries where governments are attempting to take control of regulation of the medical profession, as mentioned by Van Der Weyden.1 At their meeting on 15 February, the College presidents endorsed a two-page statement of key issues in regard to the COAG proposals. This statement has been sent to the premiers, chief ministers and health ministers in each state and territory, as well as to the relevant federal government agencies.

At the same time, it is appropriate for the Colleges to cooperate responsibly with government initiatives, provided those initiatives do not diminish in any way the safety and quality of health services provided in Australia or threaten the sovereignty of the Colleges in the determination and maintenance of standards for their respective disciplines.

To the Editor: Your statement that the present “grab for control [of Australian medicine] by governments” is unprecedented is not correct.1

Between 1946 and 1949, the federal government came close to nationalising the medical profession.2 The lines were drawn earlier. In 1941, the Federal Council of the British Medical Association (BMA) in Australia (now the Australian Medical Association) made recommendations about the provision of medical services. Two years later, in response to a report by the National Health and Medical Research Council, Outline of a possible scheme for a salaried medical service, the BMA laid down a more detailed policy, with retention of the existing (largely private) general practitioner and specialist services. The government responded by proposing a scheme under which patients would pay nothing directly for medical care, with costs to be met from general revenue.3 Asking the doctors to cooperate, the government indicated that it would if necessary seek other means to achieve its object.4

The referendum of 1946, one of the few to be passed, gave the federal government power to provide a range of social services, including pharmaceutical and hospital benefits and medical and dental services. There were, however, a few words of critical importance in the question put to the people — “but not so as to authorise any form of civil conscription”. It was the Leader of the Opposition, Mr (later Sir) Robert Menzies (acting on a request from Sir Henry Newland, President of the BMA Federal Council and a surgeon of great distinction), who moved the amendment, which the government accepted.

The referendum enabled the government in 1948 to pass the National Health Service Act 1948–49 (Cwlth). Resistance by the BMA to what it regarded as objectionable features led to an attempt to coerce the profession by enforcing the Pharmaceutical Benefits Act 1947 (Cwlth), which required compulsory use of a Formulary issued to all doctors. (In the event, only 2% of doctors ever used it.) The BMA took the issue to the High Court of Australia, which decided in August 1949 that a section of the Act amounted to civil conscription and was invalid. Later in the year, the heavy defeat of the government, the result of its attempt to nationalise the banks, sealed the doctors’ victory.5

Over the next few years, the coalition led by Menzies introduced a health service based on the principle of voluntary insurance for hospital and medical benefits, which is still in force.

There are clear lessons to be learned from this history.