Tony Smith (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Ballarat proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The government's plan to increase the cost of health and aged care for Australians

I call upon those members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places

Mr Tony Burke (Watson, Australian Labor Party, Shadow Minister for Finance) Share this | Link to this | Hansard source

I seek leave of the House to allow the member for Blair to take responsibility for the starting of the MPI.

Leave granted.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

The government well and truly has people who are engaged with the health system and aged-care system in its sights. The couple of days ago the Prime Minister was asked by the Leader of the Opposition on 9 November, if he would rule out a GST on rent and on nursing home payments. He flick-passed the ball to the Treasurer and the Treasurer told this place, 'The government is considering all options.' Aged-care services are critical to those older Australians who have saved hard for their retirement and who have contributed to the economy, the community and society which we call Australia. It is important that they have certainty. They have had no certainty from this government because in their first budget they tried to change the indexation in relation to pensions to effectively reduce the value of pensions and the capacity for older Australians to provide their housing, their food, their groceries, their health services, and their dignity and certainty in retirement. Fortunately, this place and the other place saw a bit of sense and stopped the government from undertaking that. But as I travelled around the country, attending pensioner forums and forums for older Australians, I saw the umbrage that was taken by older Australians. You saw that on the faces of those opposite and the Treasury benches, because they knew very well that older Australians were very unhappy. And they will be if the government proceeds with any plan to put 15 per cent GST on aged-care services and health services, because the government did not tell the public about any such plan when they travelled around with the blue book before the last election.

When it came to their costings, on the fiscal implications on coalition policies before the last election, released only a couple of days before the election, they said nothing at all about a 15 per cent GST. In fact, the then Leader of the Opposition, the member for Warringah, actually made the point that there would be no cuts to health and no cuts to education. He made it crystal clear that the GST rate would not change at all under him. So they get in, and what do they do in their first budget? They attack pensioners and attack our older Australians. And what have they done with respect to health services in this country to make it harder to increase the cost on older Australians and families across the country? We have seen more than $60 billion cut from Australia's public hospitals, and we have seen attempts to increase the cost of medicine for every Australian. We have seen $370 million cut from preventative health programs, thereby increasing the cost of health services to all Australians. The government's ongoing GP tax through its MBS freeze has been implemented.

They are trying to get this in a position where Australians pay more when they go to see the doctor. We know that when the former Prime Minister was minister for health the bulk-billing rates were only 67 per cent. When Labor left office the bulk-billing rates were 82 per cent. We are very proud of the fact that Labor has always supported Medicare. We always have. We have always supported the universality of Medicare, but those opposite opposed it year, after year, after year. When John Howard was the Leader of the Opposition he had a Damascus road conversion experience before 1996, but they have always set about trying to undermine the universality of Medicare, so a person's credit card was more important than their Medicare card. That is what they have always tried to do. Now the cuts are well and truly at every level of the health system.

In relation to aged care, you can imagine the costs to our older Australians and the impact on older Australians, because aged services come in a variety of different ways. They happen in residential aged-care facilities where a person has to consider paying what they call a RAD—a refundable accommodation deposit—or a daily accommodation payment, or indeed a combination of either to get into a residential aged-care facility. Then they have to pay for the care in the aged-care facility. Or when they are in their home they have to pay home care in relation to that. Imagine the cost with the GST in relation to that. Imagine the cost if you were in your home and you had to pay a GST on the services that you get to help you stay in your home. It would be a tragedy for those people. You are talking about services of transport, palliative care, dementia services, re-ablement and wellness programs, all of which help older Australians to stay fit, healthy and in their homes. But if there is a 15 per cent GST, imagine the cost to older Australians. Imagine the cost in vulnerable areas.

Think about those Australians living in remote and regional areas, because the costs will be even more because the access to services and the market is more limited. For a start, you might only have one provider in a country town who provides that. But there is another kind of service that millions of Australians have access to and many Australians really appreciate: the aged-care services of the Commonwealth Home Support Program: Meals on Wheels and what we used to call HACC. Imagine the cost of that if the government decides to put 15 per cent GST in relation to that.

The government has got to answer this because when they were in opposition they kept on asking us to rule things in or out all the time, but all of a sudden they are not prepared to do this. Older Australians need certainty, stability and they need to know that they can live their lives without this uncertainty hanging over them. I call on the Prime Minister. The minister there at the table, she should rule this in or out today so that we know exactly what is happening with respect to health and aged-care services in this country.

Members of the government and the backbenchers on marginal seats either put up with the arguments and the troubles and the travails they had to sell an unpopular policy when the government was trying to change the pension down to CPI increases only, instead of a percentage of male total average weekly earnings, or the Pensioner and Beneficiary Living Cost Index—whichever is the greater. They would have seen a massive reduction, if the government had got that through, in terms of the pension.

Imagine going to those forums they have—and we all do it—before elections and trying to justify a 15 per cent GST tax on aged-care services or in health services. Imagine the impact it is going to have on the residential aged-care sector. We have seen cuts and we have seen the government make it harder in terms of the aged-care sector. There is no aged-care workforce strategy in place. We know how hard it is in terms of residential aged care. We know how difficult it is. And the government has made it more difficult because of their complete lack of making sure that the My Aged Care website and the hotline operates properly, so there have been delays and confusion.

Whether I have gone to the Metro North Brisbane PHN meeting or have been in Bendigo or I have been in Adelaide or in my own electorate, in Ipswich, every single time, wherever I have gone to meet with aged-care providers, to meet with pensioners and seniors groups, there has been criticism. There has been criticism from seniors. The National Seniors have not been happy with it. COTA has not been happy with it. We know that doctors have not been happy with it.

The government have made it more difficult for older Australians because of their failure in aged care. In the last budget, they cut funding with respect to aged-care workforce development. How are we going to get older Australians the service they need? How are we going to get that residential aged care or home care or Commonwealth Home Support Program if we cannot get the workers to work in that area? It is going to make it more costly for older Australians.

The government have a stock take that they have had for over 500 days. They promised the stock take of the workforce issues in aged care in the country, but they have not released it. This is a stock take of their own Commonwealth government funded programs. They still have not released it. That is a shame. They should be doing the right thing. They should be doing an aged-care workforce strategy and working with the unions, working with the sector. They should be working with LASA, ACSA and COTA. They should be working with the guild. All of this should be undertaken because the cost in the aged-care sector if they do not do this will adversely impact older Australians, even without a GST.

They should also be looking to restore the funding for dementia that they cut. We know that in the last budget they changed the terminology from ACSIHAG to 'dementia and aged-care services' and cut $20 million out of the funding in discretionary grants. That makes it more difficult to get the services that people need.

The government generally have had a fairly bipartisan approach to aged care. We did the heavy lifting and the hard yards on Living Longer Living Better when we were in government. But the government have really made it more difficult because they have taken their eye off the ball in aged care, and the decisions they have made have made it more difficult in the sector. Health has been the same.

The government have a lot to answer for. They can rule this in or they can rule this out. In the aged-care sector, the Commonwealth contribution to aged care in this country is about $15.8 billion annually. It is a massive part of the portfolio and the expenditure of government. Imagine the cost in the sector if the government brings in a GST. Imagine the cost and the loss of jobs. Imagine the loss of care. Australians deserve better in health and aged care.

Sussan Ley (Farrer, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

It is a pleasure to speak on this matter of public importance today. The member for Blair has done very well, stepping in at short notice with the member for Ballarat's speaking notes. I am not sure if she would have made any additional points at the dispatch box. The fact that the opposition spokesperson for health is not in the chamber now is in part due to her hysterical intervention during question time, directed at the Prime Minister, about a question which was ridiculous. I might come back to the essence of her question and listings that we are making on the PBS compared to listings that Labor never made on the PBS.

But this matter of public importance is flawed from the outset. I will read it out again:

The Government's plan to increase the cost of health and aged care for Australians.

My very strong point today is that the government does not have a plan to increase the cost of health and aged care for Australians. The government does have a plan—

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

You're ruling a GST out, are you? You're ruling a GST out. That's great.

Sussan Ley (Farrer, Liberal Party, Minister for Health) Share this | Link to this | Hansard source

Member for Blair, I listened politely to your remarks, and I think you should do the same for mine. The government does not have a plan to increase the cost of health and aged care. Of course we do not. We have a lot of plans and a lot of policies in health which I talk about continually and I will touch on today. Labor have not so far produced a single plan, although there was one hint in mental health—an important area that I will not politicise in this place—which simply said that Labor would respond to the National Mental Health Commission review of mental health within 100 days after regaining office, if indeed they do. That is the closest that I have seen to any policy.

As ministers in the government have said continually during this question time, last question time and the question time before and will continue to say, there is no plan to introduce the GST on health. There is no plan to make the spending of our vulnerable Australians more challenging than we know it already is. However, there are plans and there are policies to do what we said we would do: build, reform and improve the system for the benefits of consumers and patients and carers. When you run your policy ideas and what you are going to do past that really important test—not the political test, not the unions test, not the programs test, not the Canberra test, not the stakeholder test, but the test: 'Who is this for?'—then you know you are on the right track.

We are not afraid to ask the difficult questions, and we are not afraid to meet the challenges that we face. A year before we left office, we, the federal government, gave in public hospital funding to the states $8 billion. Now that figure is $16 billion. The year before we left office, the cost of Medicare, the cost of the MBS, was $10 billion. Now it is $21 billion. So the costs of the two biggest components of our healthcare system have doubled in 10 years. No government worth its salt with a responsibility for the future sustainability of the nation's spending would sit on its hands and do nothing.

This appears to be what the Labor Party is asking us to do—whipping up hysteria. This has nothing to do with whether there is a GST on what. This has nothing to do with that. This has everything to do with Labor's timid holding pattern when it comes to policy. That is where we see them in private health insurance. Who would have thought that Labor would be saying, 'Don't touch private health insurance'? They did, when they were in office, to the tune of $3.5 billion. They certainly attacked private health insurance. The lesson I learned from that is that you fiddle with the rebate and you get trouble; if you look at improving affordability for consumers over the long term with good ideas, you get sensible policy reform. So Labor are in this timid holding pattern, afraid to take off with a new idea and afraid to land with anything sensible, just saying no.

I might refer the member for Blair to some comments from his senior shadow minister, the member for Ballarat, who said in February this year, in a moment of honesty—which we appreciate—that Labor would be kidding itself if it did not realise that there were areas that needed to be cut and there were cuts that needed to be made, and no area is exempt. No area is exempt. So they are the announcements that we are getting from Labor, but they have not translated into one single policy idea.

The member for Blair and speaker after speaker—and I know that other members have, because we are dealing with the Medicare safety net bill that is going through the House now and, obviously, I will have more to say about that when we sum up on the bill—have talked about the freeze on Medicare rebates. I just want to remind members opposite that it was Labor who started the freeze on MBS rebates. It was Labor who froze the indexation of the MBS and it was the then Labor health minister, the member for Sydney, who made remarks to this effect, 'Oh well, doctors earn a lot of money—maybe $350,000 a year on their billings through Medicare—so they can suck it up. It's okay.' I really would urge Labor members not to forget that the place they have come from and the place where they pretend to be are in fact very different.

I would just remind members of the House and members of the public listening to the broadcast of what this government is doing, compared to the complete inactivity and policy-free zone of Labor. The figures I mentioned indicate that health spending in these two important areas has doubled. I might add that another area of spend for the government is the PBS—the listing of medicines. I will come back to the member for Ballarat and her crazy question to the Prime Minister focusing on additional cost for medicines, because we are listing twice as many medicines—or we are listing medicines at twice the rate—as Labor ever did. There were two interesting examples, which I am not going to detail, where the then Minister for Health received advice to list medicines following their passage through the Pharmaceutical Benefits Advisory Committee. Patients were waiting—and I do not want to invoke desperate patients to make political points; I would never do that—and the minister of the day said 'No'.

That so angered members of the Liberal and National parties that on coming into government in 2013 we said that we would not do this, that we would make sure where new drugs pass safety and efficacy, and where they make sense to list, that we would not delay. Obviously, there is a negotiation at that point, where the government and the Department of Health negotiate with the pharmaceutical supplier. It is a very positive negotiation, and I want to thank those who engage in that, because they do it for the benefit of the patients. But at that point, government has a responsibility to list.

So we have already demonstrated this. The last drug we listed was Iclusig, a drug for chronic myeloid leukaemia. It was listed last week. Its actual cost is $66,000. If you are a concessional payment you access that for $6.10. As another example, who can forget Keytruda—a breakthrough drug for melanoma? The actual cost for treatment is $100,000. The cost, if you are a general patient—like the member for Blair and me—is $37. Who can forget all of the listings that we make every month in the interests of Australia's patients?

So when I say to members opposite that we are not afraid to ask the tough questions, it is not just about, 'Oh well, that's what we would do.' It is about asking, 'How do we make the Australian health spend as efficient and effective as possible?' Because we want to do these things; we want to list new drugs. The member for Blair made a comment about dementia—I am not sure where that came from. We had a $200 million commitment for dementia research when coming into government, and we have just announced $45 million for dementia research—cures for dementia.

Yesterday, I announced $630 million of research grants. I think that 840 researchers will benefit from those research grants. I have talked about the listing of medicines and I have talked about the approach we are taking to reform the MBS in order to list new procedures and new items, and to pick up contemporary clinical practice—what happens in doctors' surgeries every day. I will never apologise when members opposite ask, 'Why have you 'cut' this program?' Sometimes, yes—shock, horror!—we take a save from a program. It is a responsibility of government to ask, 'If we have scarce dollars'—increasingly scarce because of the situation left to us by Labor—'how should we best spend them, remembering to keep those dollars as close as possible to the patient?' We remember the patient's needs and we remember that it is all about the consumer. It is not about anyone else: first and foremost it is about the consumer.

The really crazy rationale coming from Labor is this: that Kevin Rudd went into the investment funds that Peter Costello created attached to the Future Fund—one of them was called the Health and Hospitals Fund. It was in fact capital; it was an investment fund. They ran that down by 75 per cent—putting money here and putting money there, promising state governments this and never really checking that the money produced the results that it needed to. And then they come in here and ask us why we have not maintained the same level of spending. It is patently ridiculous!

Please, Labor Party: go away, come up with some good policy and engage in the debate.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

Can I say to the minister: your party has been in government now for over two years and it is time you took responsibility for the position of this government's financial mess.

I want to begin my contribution with a quotation:

He who has health, has hope; and he who has hope, has everything.

The quotation encapsulates how good health is at the heart of our very being. Indeed, I can think of no other area of public policy that matters more to people than good health policy, because when a person has poor health little else matters to them or to their family. That is why this government's attacks on Australia's health system and aged-care services—the funding cuts that we have seen imposed and the attempts to Americanise our health system—are not only bad public policies but will ultimately be rejected by the Australian people.

They will not be treated as fools, as they have already shown. They can do their own sums and they will not be seduced by the Prime Minister's continual rhetoric about fairness. I say, with respect, that all we hear is the Prime Minister coming into this place day in and day out, talking about how he wants everything to be so fair. The truth of the matter is that there is nothing more unfair than imposing additional costs on people who cannot afford the health care they need.

It is not a matter of what the Prime Minister actually says; it is more a case of what he does, and that is what we should be looking at. When you look at what he does, he was part of the government that came in two years ago, and more, and brought in a whole raft of changes with respect to the health system of Australia.

I want to turn to the American system, just for a moment, because that is clearly where this government is heading with respect to our system in Australia. It is a system where those who can afford health care are looked after and those who cannot afford it miss out. We know that when you miss out that you cannot afford the health costs, because if it is a serious health issue those health costs can run into tens of thousands of dollars. In the US, they spend about 18 per cent of their GDP on health costs across the country. Most of it comes from the pockets of individuals. Yet life expectancy in the US is much lower than it is in many other developed countries, including here in Australia, where we spend around nine per cent of GDP on health yet we have a much longer life expectancy, as do most other advanced countries, who spend about the same proportion of their GDP. The point I make about that is that the American system does not work and does not give you the health outcomes that are required, and indeed the flip side is true: Australia is not expending such an exorbitant amount on health costs that we need to make the drastic cuts that this government wants to push through.

We now know that on top of the health system that this government wants to dismantle—and we have seen cuts of $60 billion from the public hospital system, $370 million from preventative health programs, $2 billion with respect to the MBS freeze on GPs, and other cuts to mental health, Indigenous health and dental programs and so on—the government is looking at introducing a 15 per cent GST across the board. The government will not deny or admit any of that, because it keeps talking about the fact that we have to have a conversation about it, but the fact that it is not denying it means that it is part of its plan and something that it wants to consider. If a 15 per cent GST is introduced, just as it affects the lower income families of Australia in every other sector, it will particularly hit the lower income families of Australia when it comes to health.

Amongst those that are in the lower income bracket of Australia are older Australians, and we have just heard the member for Blair talking about that and highlighting just how this will hit older Australians very hard. I have spoken to older Australians in my own electorate.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

I was there.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

Absolutely. The member for Blair was there. We had a forum, and I can assure members opposite that their concerns are real and they can do their sums and they know what is happening to them. When the minister says that the changes that are being made by this government are all for the better, can I say to her: if that is the case, why is the government under so much pressure and criticism from just about every medical sector out there in the community? The fact remains that the changes that this government wants to introduce, including the changes to do with the private insurance scheme whereby your health will determine the costs you pay, are simply not going to be worn by the Australian people. You cannot improve a health system by cutting costs, and cutting government expenditure on health care can only lead to increased costs to the public and to older Australians.

Ken Wyatt (Hasluck, Liberal Party, Assistant Minister for Health) Share this | Link to this | Hansard source

I wish to associate myself with the comments made by Minister Ley. It certainly is bold of the opposition to stand here today and talk about health and ageing. It absolutely galls me to witness the member for Ballarat and the member for Blair attempting to hoodwink Australian people through scaremongering on a range of fronts and not being truthful in the comments that they are making. It is behaviour that is becoming typical of Labor. Their signature scaremongering has become boring and predictable, and we saw that in question time today. I am livid that they are standing here today and attempting to deny the Australian people, including the people of my electorate, their right to have a say.

We on this side of the House have proven time and time again that we want to take a consultative approach to health and ageing. Under Minister Fifield, for example, we called for feedback on Commonwealth aged care advocacy services to assure older Australians and their families and carers about their rights and responsibilities when accessing aged-care services. Now, under Minister Ley, an online survey has been released that asks consumers for their views on private health insurance and how they think it can deliver better value for money.

Mr Neumann interjecting—

The member for Blair may want to intervene and interject, and that is fine, but be truthful in what you say to fellow Australians. Unlike Labor, the Turnbull government does not fear the collective voice of the people we represent. We speak to mum and dad voters of Australia about their health and their health care and believe that private health insurance is a fundamental part of our health system. The fact of the matter is that Australians dumped or downgraded half a million all-inclusive private health insurance policies after Labor's $3.5 billion worth of cuts to private health insurance, including cutting $2.4 billion from the government's private health insurance rebate; linking the indexation of private health insurance rebate to the consumer price index, cutting $700 million; and cutting $389 million from the private health insurance rebate for people with policies that are also paying the lifetime health cover loading. Ultimately this forced up premiums for 10.6 million Australians with hospital cover, leaving them angry and confused.

Ms King interjecting—

Member for Ballarat, you know what you have done. The member for Ballarat and the member for Blair are out of touch with mainstream Australia when the member for Ballarat implies that private health insurance is for the rich. Five point six million Australians with private health insurance have an annual household income of less than $50,000, and 3.4 million have an annual household income of less than $35,000. Labor's cuts to private health insurance only saw these people experience further cost-of-living pressures during the Rudd-Gillard-Rudd years of chaos.

At the end of the day, Labor's track record when it comes to health and aged care speaks for itself. It is ironic that the member for Blair refers to dementia support when Labor's flawed dementia and severe behaviours supplement had to be ceased last year after they incompetently budgeted $11.7 million and, in the first year of operation alone, costs blew out to $135 million, and it was not sustainable.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

Under your watch. Under your watch it blew it out.

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

Order! The assistant minister has the call. The member for Blair!

Ken Wyatt (Hasluck, Liberal Party, Assistant Minister for Health) Share this | Link to this | Hansard source

Unlike those opposite, Minister Ley and I have consulted with the aged-care industry to design a response team approach that will deliver support for residents with dementia and operate within the original funding envelope.

Labor promised health reform and failed to deliver. They promised a plan to fix hospitals and failed to deliver. They promised to slash elective surgery waiting lists and failed to deliver. In fact, the COAG Reform Council found that the average national waiting time for elective surgery increased under the Labor-led government. Under those opposite, bureaucracy ballooned while public hospitals, private health insurance, dental and other areas faced cuts.

While those opposite are standing here today crying crocodile tears over health reform they could not deliver, we are getting on with the job of ensuring everyday Australians have access to a 21st century healthcare system that is affordable and sustainable into the future. I hear the member for Blair saying it is not true, but when you read the COAG reports that were tabled and have a look at the reports that were provided by state and territory governments—

Ms King interjecting—

it was evident, Member for Ballarat, that you had failed in your healthcare delivery approach. The 'no blame' healthcare report under the Rudd government also failed to deliver the outcomes that Australians were expecting, and again you are scaremongering. Stop it. You are creating fear.

Ms Catherine King (Ballarat, Australian Labor Party, Shadow Minister for Health) Share this | Link to this | Hansard source

As fans of Yes Minister know, you can get any answer you want from a survey depending on how you frame the questions. When Sir Humphrey asks Bernard if he thinks teenagers need more discipline and leadership, he agrees that national service is a good idea. But when he is instead asked if it is dangerous to arm teenagers and teach them how to kill, Bernard finds the idea of national service frankly horrifying.

So when a government that has sought at every turn to undermine Medicare launches a survey which attacks two of the fundamental foundations of our healthcare system—community rating and universal access to healthcare—we know precisely what is going on here. When the survey asks whether private health insurance should be allowed to cover GP consultations, it is important to spell out precisely what this option would mean: the undermining of universal access to healthcare—the fundamental principle of Australia's Medicare system.

As the former secretary of the Commonwealth Department of Health, Stephen Duckett has pointed out, our existing high rates of bulk billing act as a lid on prices:

If patients with insurance face no out-of-pocket costs, GPs might feel they can safely increase their fees for half the population—those with health insurance—with no impact on demand for their services.

…   …   …

As well as charging insured patients more, GPs might decide to charge uninsured patients more, or reduce the number of services that they bulk bill. So the second impact of the change would probably be to reduce access to care for the uninsured.

So this is a policy that will drive up fees and cost the health system more, while making it harder for people to see their doctor.

The survey makes clear there is another agenda here as well. That is to prop up private health insurance by scrapping community rating and enabling health funds to risk rate members according to age, gender or health condition. And with the lead-in to the question which suggests that people over 70 are a huge burden to the health system, it is pretty clear this is about charging older Australians more for their health insurance. Brent Walker, a health fund actuary with 40 years experience, says that this policy is 'nonsense' and warns:

Health funds in New Zealand risk rate and when you turn 65 the premiums almost double, by the time you are 70 you can’t afford health insurance in New Zealand.

National Seniors has described the consequences for older Australians from risk rating as 'diabolical'.

The survey, of course, also asks if health premiums should be priced according to gender, which, according to Mr Walker simply means higher premiums for women of child-bearing age. Finally, it asks if different premiums should be charged according to a person's health or their health risk factors. This goes way beyond smoking, because when you scrap community rating and say that people should pay more on the basis of their health risk, where do you draw the line? Should people be charged more because they are overweight? What about ex-smokers, those who have three glasses of wine instead of two or those with Fitbits who do not register 10,000 steps a day? And, much more seriously, what about people with a family history of cancer or heart disease?

Just as important are the questions the survey fails to ask, such as whether to continue the current means testing of the private health insurance rebate, which the minister has repeatedly suggested she would like to reverse. I would look forward to seeing the $3 billion hit that would have to the budget contained in MYEFO.

The minister dismisses our concerns by insisting that this is just a modest survey, as if this were some sort of university exercise rather than the Commonwealth government and the Minister for Health conducting this sort of survey. It is an absurd proposition. You do not ask these sorts of questions, as a Commonwealth Minister for Health, in this loaded fashion unless you already know what the answers are. I will not be surprised if the minister uses this survey to give private health funds what they have been pushing to achieve for some time—an entry into general practice and a start down the path of risk rating. The only question is of course what she is going to want in return. It is a push poll designed to undermine Medicare and to benefit private insurers at the expense of consumers. It should be called exactly what it is.

The minister is trying to say that this is all Labor's fault. She has made no mention of the fact that a lot of the downgrading of insurance product has occurred at the instigation of private health insurers themselves when they tell people their products are no longer available. This survey is an absolute fraud. (Time expired)

Mark Coulton (Parkes, National Party) Share this | Link to this | Hansard source

If there is an upside to the member for Ballarat's bad behaviour in question time it is that we only got a five-minute contribution instead of a 10-minute one. Once again, we are hearing a shrill and churlish contribution from the shadow minister for health. It was a nice bookend to the old regular, the member for Blair, who can mount a scare campaign with the best of the rest of them. It was interesting to listen to the member for Blair criticising the aged-care schemes that were actually put in by his own government.

There are two things I do know about older Australians, Member for Blair. One is that they can be easily frightened about their future security and health needs by a scare campaign, as we are seeing now. The other thing about older Australians is that they want to leave their country in a better state for their children and grandchildren than they had for themselves.

What we saw under the Labor government was that their approach to aged care and health care was to dress the Prime Minister in a set of scrubs and march him around the countryside over a couple of months with photo opportunities in operating rooms and emergency rooms. They came up with a plan that basically raided the savings of the Australian people. What we have now with the current Turnbull government is a government that is actually governing and managing healthcare, aged care and the finances of this nation with an eye to the future. The previous government acted like a mob of squatters that had moved into the House and squandered the assets without any real thought to the long-term sustainability.

Today we are talking about: how are we going to manage health care and aged care in a sustainable fashion to ensure that we have got a system in place for the baby boomers in 20 years time—when Australia reaches its maximum capacity to care for older people—that will still be viable and relevant to the country at that particular time?

So there is no doubt that aged care and health care are significant factors, and we have got members here—and the member for Makin had his contribution as well—who talked about the needs of older Australians. Those opposite were the ones who were hell-bent on introducing a carbon tax that had the older people in my electorate too frightened to turn on their air conditioners in summer and their heaters in winter. Our Meals on Wheels volunteers were finding people under the doona in the middle of the day, because they were not going to turn on the switches in their houses.

We need to manage this issue in a responsible fashion. It does not mean forking out money hand over fist, raiding the savings of this nation and making our children and grandchildren pay for our own care. We need to make sure that we set this country up so that we can leave it sound, stable and viable in the future. What we have seen with the health minister's survey is: consultation with the public to engage with what the people of Australia really think, and need and act accordingly.

Once again, we have seen a matter of public importance brought on by members of the opposition—and indeed aged care and health care are matters of public importance. If you survey the members of my electorate, aged care comes up as the No. 1 issue. Therefore it should be treated with a level of responsibility and respect for the people who are very much relying on this system. It should not be seen as a tool to scare people with bogus claims about increasing GST or a whole heap of other things that are not actually on the table; we should be dealing with this and the facts in a sensible manner.

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Link to this | Hansard source

I have been riveted by this debate—riveted in the sense—

Luke Simpkins (Cowan, Liberal Party) Share this | Link to this | Hansard source

You weren't here for most of it!

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Link to this | Hansard source

Unlike you, I actually can use the television. Whilst watching the debate, I was transfixed by the stupidity of the arguments coming from the government. Because not once did they seek to defend their position while the opposition was calling them to account. The member for Hasluck said disparagingly, 'All you are are critics. All you do is criticise. You come on and scaremonger.' Goodness me! Let me just ask you a very simple question: if the Prime Minister at question time could not discount increasing the GST to 15 per cent, why shouldn't we be saying to the Australian people: you should be concerned about it? Why haven't you ruled out the GST?

Let me ask you a question, member for Hasluck: in my community, the issues that emerge are very, very important. On the prospect of a GST increase, Stephen Duckett from the Grattan Institute said:

… allowing insurers to cover GP visits could undermine universal access to healthcare—the fundamental principle of Australia's Medicare system.

He went on to say:

If health insurers could cover GP visits, they may pay doctors more than the Medicare rate, changing the market dynamics … That would be inflationary and it might have a flow-on effect to people without health insurance who will be expected to pay.

On the question of the GST, Professor Owler, President of the AMA, said that 'placing the GST on health services'—including services to the aged—'would hurt the most vulnerable and disadvantaged in the community'—and I might say the sickest and the people I am most concerned about it.

Let me just ask you this question: if the government is not intent on increasing the GST across items, including food; increasing the GST on petrol; and including the GST on health services, why doesn't it discount it? Why doesn't it say to the Australian people: 'Don't worry about it; we're not going to do it'? Because the Australian people have got every right to ask that question.

In my own communities in the Northern Territory, the sickest, poorest and most remote Australians live in my electorate. The people with the lowest socioeconomic outcomes in Australia—the people I am concerned about—are the sickest. They are 3.7 times more likely to have chronic kidney disease. They are 3.3 times more likely to have diabetes than other Australians. And what you are proposing to do, potentially, is increase the GST on health, food and other essential items, broadening the base and increasing the rate. Australians who live in remote communities know what you are about and, if you are very serious about this, you should say to the Australian people: 'Yes, we're going to do it' or 'No, we're not.'

Stop this game of saying: 'We don't have a policy.' We know you have got a policy; you just won't articulate it. We are articulating it for you, and you express concern about it. When we say you are going to increase the GST by 15 per cent and broaden the base, you should know this: those with the most acute rates of chronic disease, diabetes, heart disease, trachoma are the people who are going to be the most adversely affected by your ridiculous proposals on the GST and the ones worst affected by the changes you have made to health.

The $60 billion cuts to hospital services—who do they impact most on? Let us just ask that simple question. I walk around my electorate, I drive around it, I fly around it and I talk to great Australians but, by God, they are poor and some of them are very sick—and they are sick and tired of what is going on with this government. They know what is being proposed by the government in terms of a GST; what the government has done in terms of cutting health expenditure, including hospitals; and the $160 million out of Aboriginal and Torres Strait Islander health.

How do you say to people that you have not cut health expenditure when your own budget papers show it very clearly that you have? Why would you say to Aboriginal and Torres Strait Islander Australians: 'Don’t worry. We'll just cut $160 million out of preventative measures.' For the sickest Australians, prevention is the most important issue, and you have cut $160 million out of their budget. Any reasonable Australian understanding what has been going on here would agree with us. You need to be condemned for what you are doing. The Prime Minister needs to get up here and, instead of obfuscating, tell the Australian people of what he really thinks as opposed to what he wants us to think.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

This MPI topic is a very serious and complicated matter, and should be treated as such. Government administration of health is one of the most important policy responsibilities that we carry. Health policy should never remain stagnant, as health technologies, treatments and testing, and therefore disease management constantly change.

Commonwealth spending on Medicare has more than doubled from $8 billion in 2004 to $20 billion today, yet we raise only $10 billion from the Medicare levy. Ten years ago, the Medicare levy covered 67 per cent of the cost of Medicare, but now it covers only 54 per cent. This is why this government is conducting a once-in-a-generation review of the Medicare Benefits Schedule as part of our plan for a healthier Medicare. This review is looking at all of the more than 5,700 Medicare items, with a view of ensuring they are clinically contemporary and effective. This is the kind of rationale, sensible policy making that those opposite are too lazy and too short-sighted to achieve in the six years they had in government. The review is led by clinicians and supported by allied healthcare practitioners and consumers.

As the minister has already stated, the pause on indexation of MBS rebates will remain while the government works to reform the Medicare system and identify waste and inefficiencies through the MBS Review Taskforce and the Primary Health Care Advisory Group. As an article of good faith, the Minister for Health is open to a future review of the indexation pause as the work on reform progresses.

In contrast, Labor failed to deliver on their big promise of health reform. At the 2007 election, Labor promised a plan to fix hospitals and, if that was not achieved by mid-2009, that a referendum would be held to seek to take financial control of Australia's 750 public hospitals. In 2008, the Labor government promised to slash elective surgery waiting lists, yet the COAG Reform Council in its report on health care found the average national waiting time for elective surgery increased from 34 to 36 days between 2007-08 and 2011-12. It also found the waiting times of the 90th percentile—those waiting longest—increased from 235 days to 251 days.

The Labor government announced three supposed historic health reform agreements. Each was watered-down version of the previous one. Bureaucracy ballooned, while public hospitals, private healthcare insurance, dental and other areas have faced cuts. Average staffing numbers for the whole portfolio increased from under 5,000 in 2006 to over 6,300 in 2011, an increase of 27 per cent. The previous Labor government announced $1.6 billion reduction in public hospital funding and cut $3.5 billion from private healthcare insurance, forcing up premiums for over 10.6 million Australians with hospital cover.

The electorate of Bennelong is fortunate to be the home of the majority of Australia's pharmaceutical companies, innovative businesses that employ thousands of people and industry that invests its weight in research and development and that comprises one of our nation's largest non-mining export products.

Recently, I was delighted to welcome the Deputy Prime Minister to tour the AstraZeneca manufacturing facility in North Ryde—the largest pharmaceutical manufacturing export facility in this country. Guided by their new managing director Paul Spittle, the Deputy Prime Minister and I were amazed at the massive size and scale of the manufacturing of asthma medication, primarily for export to a growing market in China. It was hard not to recall the work that I did with AstraZeneca and many other Medicines Australia companies shortly after I was elected in 2010, as the Labor government made unprecedented changes to the convention on how governments list medicines on the PBS, in direct contradiction to the memorandum of understanding they had signed with the industry just several months earlier.

Of course, they were very happy to pocket the nearly $2 billion in savings committed to by the industry as part of the agreement. Several months later the Gillard government refused to list a number of medicines on the PBS that had been recommended by the independent PBAC, denying patients timely access to new medicines that had been independently assessed as safe and cost-effective. After substantial political pressure and a Senate inquiry— (Time expired)

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Yet again, we are debating the government's abject failure in the area of health and aged care. It has a unique approach to health care—cut the services and charge more. Its approach to health care is to make Australians pay for everything that they get, whilst at the same time reducing those services. The Turnbull-Abbott government has been an abject failure in the area of health. We have had one health minister who was described as the worst heath minister in Australia's history, and now we have another health minister who is really making a hash of it. This government's approach to health care is all about efficiencies. It cuts but it does not, at any time, put in place any new services.

An MBS review? Yes when we were in government we undertook reviews. We support MBS reviews, but what you do is replace old technologies with new technologies and not put the money back into the budget bottom line. This government has one consistent approach to health, and that is to attack it.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

To cut it.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

Yes—cut, cut, cut, cut. As much as I hate to stand up in this place and say this, this government does not—and I emphasise 'does not'—support universal health care. It has an ideological commitment to the privatisation of health. It wants to see a health system that is the same as the American health system, a system where those people that can afford to pay get the absolute best health care that they can possibly have, whilst those people who do not have as much money, do not have as many resources, go without. The sick and the poor get sicker. That is a disgrace. It is a disgrace when you have a government that wants to make Australians provide for their own health by paying for it with their credit card, not with their Medicare card.

This week we have seen the Minister for Health sink to a new low, with the private health insurance survey. It is nothing but push polling and an attempt to end community rating and instate risk rating. Shortland electorate is an older electorate, with lots of older Australians. I see the shadow minister for ageing here, and he understands the issues that are confronting older Australians. They are constantly under pressure, and of course we have got the GST lurking in the background—will it be applied to aged care; will it be applied to health? The government will not rule it out. We have problems with aged care. It has been such a failure. They have removed the dementia funding—all gone.

I will get back to this dreadful health survey. It looks at whether older Australians should have to pay more. I can tell you that the people in Shortland electorate are not wealthy, but they have had health insurance all their lives. For them to be hit with an increase is unacceptable. Talking about obesity, I had a constituent contact me this week saying, 'Obesity is not a lifestyle choice.' He called that attitude disgusting and dangerous. The AMA President, Brian Owler, condemns this government for this survey and the actions it is taking—many actions. And the National Seniors are disgusted with it. The one thing I have to say is that this government does not understand health. It does not get health. It does not get aged care. It does not understand how important it is and that it is a role of government to deliver it.

Melissa Price (Durack, Liberal Party) Share this | Link to this | Hansard source

I am very pleased to speak on this matter of public importance and to help smash the myths perpetuated by those on the other side. We on this side have got a lot to say, especially about health care in the bush. We on this side continue to be on the moral high ground when it comes to health, with the Turnbull government increasing funding to WA hospitals by 27 per cent over the next four years. This is an increase of $469 million, a mammoth increase by anyone's judgement. In my patch, rural, regional and remote areas received about one-third of the total Medicare Benefits Schedule benefits paid across all of Australia in 2014-15. So it is unfathomable why those sitting opposite try to attack this government on health. One would think they had nothing better to do with their time.

In the 2015 budget, the government increased funding to a number of health initiatives and services. The government boosted funding to the Royal Flying Doctor Service to the tune of $20 million over the next two years. This brings funding across the forward estimates to over $137 million, which is a huge boost to my electorate of Durack and regional Australia. We announced the redesign of the General Practice Rural Incentives Program to better support delivery of medical services in rural and remote communities. We are also creating a new Health Workforce Scholarship Program, including rural return-of-service obligations to boost the rural workforce. We also announced new and amended MBS listings to assist rural and remote Australia. A couple of examples are new MBS items for targeted interactive radiotherapy for early-stage breast cancer and for remote monitoring of patients with implanted cardiac devices, which will eliminate travel for routine matters. These commitments build on the 2014 budget commitments, which include $40 million over four years to create more inter training opportunities in private hospitals in rural and regional areas and over $52 million for infrastructure grants to support the teaching and supervision of the rural and regional medical workforce. Since I was elected as the member for Durack just over two years ago, the government have announced a number of health initiatives in my area alone. I am particularly proud of the new cancer centre which will open in Geraldton in the near future and the headspace which is coming to Geraldton—and I am currently talking with key stakeholders in the Pilbara to get one in that region as well.

It is Labor's 'year of the big idea'. This is the best they have got today. One would say that is a bit of a joke. I would say it is more of a year of negativity. Talking of Labor ideas, I noticed with sheer horror—yes, horror—the recent Labor announcement of a proposed $10 billion in infrastructure projects. I noted that these were all in cities. None were in regional Australia, so Durack would miss out should we have those opposite holding onto the reins. It is yet another example of how those on the other side do not know what the needs of rural and regional Australia are and, if they did, they would not care about them. They illustrated that with that announcement.

I note the latest—not so scary—scare campaign, about a 15 per cent GST, that Labor have been trying to execute, unconvincingly. As our Prime Minister has said ad nauseam, any change to the tax system must be fair, and any increased burden will be borne by those best able to pay for it. The future prosperity of Australia is not just about reforming one type of tax or taxes, full stop. What we require is a review of the whole range of taxes, including company tax, and to acknowledge and do something about bracket creep. These are the things we need to talk about. But we on this side are up to the job. You know what else we are up to—we are up to looking after the health sector, because it is in very safe hands.

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

The discussion has concluded.