Annette Ellis (Canberra, Australian Labor Party) Share this | Hansard source

I am pleased to have the opportunity to rise in the House today to speak on the Private Health Insurance Bill 2006 and related bills, but I speak with a little bit of concern. I have concern for those with private health insurance who may in the future—we do not know, but we can predict—find themselves eventually facing higher premiums; I have concern for those in our community who cannot afford private health insurance; I have concern for the professional independence of medical professionals; and, in particular, I have great concern about where this government is taking our nation when it comes to health care. I am happy to say that we on this side of the House are honestly supporting this bill. My colleague the member for Gellibrand has moved a second reading amendment that is essential, in my mind, to making this package of bills fair and worthwhile, and I am happily, wholeheartedly supporting that amendment.

For the first time ever I actually agree with the Minister for Health and Aging when he says these bills represent the most significant change to private health insurance in the last five years. The provisions in the bills covering broader health cover are certainly welcome. Where it is deemed clinically appropriate by a medical professional, out-of-hospital services should be able to be covered by private health insurance. Services such as chemotherapy, dialysis and allied health services can be effectively and efficiently delivered in domestic or community based settings. These services should not be limited to hospitals, where scarce hospital beds are occupied unnecessarily in those cases.

For the first time these out-of-hospital services will be covered by private health insurance. We on this side of the House welcome that initiative. The broader health cover provisions in the bills will also allow private health cover for preventative treatments, health promotion programs and chronic disease management. The government should be congratulated on finally taking action on preventative disease management particularly. This is an area that Labor has been very vocal on in the last 10 years, and I welcome the government’s decision to improve access to these programs, even if it is only for private health insurance holders and not the community at large. But more on that in a moment.

Given there is no detail in the bills as to what the rules will be for treatments to qualify under broader health cover, I have strong concerns that, for want of a better term, lifestyle programs may be included. Whilst a very broad range of activities can have preventative health benefits, I would be concerned that any alleged benefit can be substantiated in a clinical setting.

One of my major concerns with the package of bills as introduced is that it does not protect explicitly the clinical independence of medical professionals in determining the most appropriate medical treatment for their patients. I understand that the AMA has raised similar concerns. Labor does not want to see a situation where private health insurance companies are dictating what types of services will be offered to patients solely on the basis of cost to the health insurance companies. Those are decisions to concern doctors, not insurance companies. The member for Gellibrand has addressed this in her second reading amendment to these bills. I call on the government to support that amendment—and to at least think carefully about it. Any failure by the government to support this amendment should be a clear warning to the public that this government’s priority could be seen as industry profit, not patient profit.

My final and paramount concern in relation to broader health cover is that the government has chosen only to provide these services to privately insured patients. The previous speaker, the member for Riverina, put, in her words, a very strong case for why this is probably a good thing. There is a certain benevolence about the way the argument was put: that those people who can afford private health insurance should not be ashamed of having it—well, nobody is claiming they should be—and that they should feel good about the fact that by doing so they are assisting those other poorer folk who cannot afford health insurance.

I do not think the access of health care in this country should be based on benevolence from anybody; it should be based on need, equity and access. Public patients in public hospitals and their doctors deserve to be given the same options for medical treatment as privately insured patients. The member for Riverina—and I am only using her words, because I was here to hear them—made a big call. She described very carefully how it is more comfortable, more secure and better for your health to resort to a home or a close-by community setting to receive particular types of services. Those very same claims could be made by a Medicare patient. They could equally be more safe, more secure, more comfortable and more in tune with their community by receiving these types of treatments at home. The benevolence should be removed out of it. And I say that with the greatest of respect to the member for Riverina and other members who may have that attitude.

We should not have a range of preventative and disease management treatments that are available only to those in our community who can afford private health insurance. The minister opened his second reading speech with the words:

This government is committed to choice in health care.

This government is threatening the universality of our healthcare system by providing choices to private patients that are not available to public patients. The minister went on to say:

This is a groundbreaking change.

My question to the minister is: is this groundbreaking change not suitable for public patients, who are predominantly working families, low-income earners, welfare recipients, older members of our community and many people who make an enormous sacrifice to try to attain private health insurance—the majority of whom, of course, are Medicare or public patients? I ask the question: is it a good thing that we can see that they could be treated as second-class citizens under what now begins to emerge as a two-tiered system of health? Are they to be denied the choices offered to those with private health insurance? If this government is serious about choice, it should fund public hospitals so that the same treatment choices can be offered to public patients as is offered to private patients.

I support a balance in health care between the public and private sectors. I have never said and I never will that there should not be private health insurance. It is a two-pronged approach that this community has managed for many years. My fear with this legislation is that the balance is now beginning to be tipped too far in one direction—the direction of private health insurance policyholders. If public patients do not have access to the same prevention and disease management programs as privately insured patients, surely they will be more likely to be admitted to hospital or seek the services of their local GP.

I note that last week the minister for health was crowing quite loudly about his success in raising the levels of bulk-billing for GP services—fair enough. I would like to congratulate the minister on his government’s efforts. Here in the ACT, bulk-billing rates for non-referred GP attendances in 2005-06 was 21.8 per cent lower—that is right, lower—than in 1995-96. Over the 10 years of this government we have gone backwards on bulk-billing in the ACT. On top of that, ACT residents pay higher out-of-pocket expenses than anyone else in the country when visiting a GP. In fact it is almost double the national average. The figures get even worse when we look at bulk-billing rates for operations. In the ACT less than 22 per cent of operations were bulk-billed to Medicare in 2005-06, down from over 27 per cent when this government came to office—1995-96.

My other concern with the broader health cover provisions is that, with the addition of so many new services, premiums will continue to rise at levels well above inflation, putting further pressure on family budgets or even putting private health insurance out of the reach of many families who are already being squeezed by rising interest rates, the price of petrol—which has been jumping up and down like a yoyo—and grocery bills. The cost of living is increasing. As private health insurers broaden their service base, my fear is that their cost base will broaden also. If recent history is anything to go by, and it usually is, private health insurance premiums have increased twice as fast as the rate of inflation since 1998.

Labor recognise that many families have struggled to meet these increases. I would like to take this opportunity to assure private health insurance customers in my electorate that Labor are committed to keeping the 30 per cent health insurance rebate. Many families and individuals have factored this rebate into their household budgets when it comes to being able to afford private health cover. They rely on the rebate to make ends meet. And Labor are committed to keeping that rebate in place. We will not pull the rug out from under their feet. We have said that constantly. I understand very clearly the efforts to which some older folk and families go to try to have private health insurance. When you look at the sorts of services that they try to get you can understand why they do that.

One element in the package of bills that we on this side of the House are very critical of is the $50 million allocated in the last budget to health insurers to promote their services. This money could and should be spent on more productive areas within the health budget. Disease awareness and prevention programs for the whole community could be well funded with this money. My colleague the member for Gellibrand pointed out in her speech that this money would cover 1.5 million GP visits. That is a lot. That would be money well spent. The $50 million on health insurance advertising is a waste of taxpayers’ money and should be diverted to providing health services for all Australians, not only those with private health insurance. I reiterate: the delivery and receipt of health services in this country has nothing to do with benevolence or helping some part of our community feel good and warm in the tummy about helping others get health services; it is all about equity, access and universality.

I am pleased that these services are now going to be available; they are sensible. The previous speaker, the member for Riverina, made that very clear and I agree with her. They are very sensible ideas but they should not be confined to only those people on private health insurance. That is wrong. The point that has been made by many speakers on the other side is that this will help us get well, make recovery better and deliver services better. Any public patient in my electorate or in any community in this country who is a public patient and requires chemotherapy, dialysis or whatever the other services are, is no less a person by wanting to have it in their home or their community setting like a private health insurance patient will be able to after the passage of these bills.

I say to the government: think very clearly about the path of health care you are taking in this country if you provide these services only to privately insured patients. It is not equitable, it is not accessible, it is not fair and it is not the way health services should be delivered in this country.

As far as I am concerned, the government’s record on the delivery of health is atrocious, and the $50 million of taxpayers’ money going on glossy advertising is crazy. That, in fact, would begin the process that I am talking about in relation to public patients. Of course, we support these bills but I again draw the attention of the House to the amendment to the second reading moved by the member for Gellibrand. It is important, sensible and fair, and would make an enormous improvement to this package of bills should the government have a spark of intelligence and decide that they should support such an amendment. We would be far more comfortable if that were the case.

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