Tuesday, 2 June 2009
Fairer Private Health Insurance Incentives Bill 2009; Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Bill 2009; Fairer Private Health Insurance Incentives (Medicare Levy Surcharge — Fringe Benefits) Bill 2009
I rise to speak on this package of legislation, the Fairer Private Health Insurance Incentives Bill 2009 and related bills. Of the first two points that I would like to make, the first is procedural as to the naming of the bills. This is the second package of legislation before us today—the first was the Fair Work (Transitional Provisions and Consequential Amendments) Bill 2009 package—to reflect fascination with the use of ‘fair’ or ‘fairer’ in the naming of legislation. In the eyes of many in the community, I think they would suggest that that is for them to decide, not for government to tell them through the language used in these packages. When we are seeing in this particular legislation before us rebates down and surcharges up, the use of the word ‘fairer’ has a fair element of audaciousness about it. The second point concerns the time frame in that the date of effect is 1 July 2009, only 30 days away. As a purist as to parliamentary processes, it would be nice to see healthy debate—and also respect for the parliament—well in advance of legislation going through this place. Respect should be given to all members and to the role that the parliament plays in deciding on and potentially amending legislation. I note the issue of the alcopops tax, even though I am supportive of the government position. The financial implications of the role that the parliament played, when the timing of the passage of the legislation did not marry up with some financial implications, should be a stark reminder, I hope, to everyone that the parliament deserves respect, with legislation being presented well in advance of potential dates of implementation.
As far as the legislation before us is concerned, it touches on two questions. The first is the issue of the universality of public health generally in Australia and the second goes to revenue. On the first question of the role that private health insurance plays in Australia, I would hope it is broadly agreed by every member of this place representing every constituency or political party that universal free health is not and never was intended as a system of delivery of health within Australia. Even the architects, Graham Richardson and Paul Keating, talked about the need for a private health package in the delivery of universal health care, which is almost a mythical term in the delivery of health care in Australia and one that I think needs to be taken out of the language by anyone in a public position when talking about the delivery of health care. We do need a private health system to make the public health system work within this country. It is a fine balancing act and any changes are therefore sensitive and certainly I will be adopt a very close watching brief in regards to the implications of changes, such as those in this package, to that very fine balancing act between the private and the public systems within Australia. We are hearing healthy debate over this legislation from both sides of the chamber as to the implications as to how many people will be staying in and how many people will be leaving and the flow-on implications for the public system. I will certainly be watching very closely. I think the question can really only be answered as time passes as to whether the pressures being placed on the public health system as a consequence of these changes are acute and therefore unwelcome as part of budget package that has been put forward by the government.
We in the area of the mid North Coast have lived and breathed this issue of private versus public, and it has been an incredibly divisive issue for the community of Port Macquarie in particular. For anyone who has followed the health debate, the Port Macquarie Base Hospital was the first and really only privately run public hospital to be delivered in Australia and there were a whole range of both positive and negative consequences of what I have referred to as that fine balancing act. In February 2005 that hospital was bought back and reconnected into public health system. Again, there are positives and negatives from that reconnection into the public system. One of the unique benefits that has been left for our region is that we have 35 specialists who have based themselves in Port Macquarie and are delivering a standard of specialist health care that is the envy of most regions in Australia, the reason for that being that, when it was a privately run public hospital, there was a fair bit of autonomy on the part of CEOs and decision makers within the range of companies that ran the hospital at various times. That allowed for some decisions to be made quickly in the placing and the buying of specialist services for our community. We now have a really good collegiate feel among our medical specialists. As I said previously, ours is the envy of regional Australia, particularly as to the number of specialists.
It is a fine balancing act though so, once again, any changes can upset all that in what is a pretty skinny market that we and specialists work in in the delivery of health care in a regional centre. Whilst changes may quite often be made in considering some great packages that metropolitan specialists are on, I would hope consideration is also given to this high-wire act of the delivery of health care in regional areas. Now that the hospital is back in the public health network, we have got these specialists largely working on rotation among three local public hospitals—Kempsey, Wauchope and Port Macquarie—as well as balancing that with their own private lists. Once again I will be talking with and listening to those specialists and with health administrators as to the implications of changes such as these and the various changes to the costs in the delivery of various services. Cataract service delivery in particular is one that has already arisen in my regional centre. Whilst certainly allowing the government their mandate, we will be watching the effect of this range of changes that we are seeing in the budget very closely and we will be listening very closely. If it does jeopardise the delivery of health care in what is a very sensitive health delivery environment on the mid North Coast of New South Wales, this is a conversation we will continue to have with the government of the day and hopefully we will see this issue addressed in the future.
The question of pressures on public health also fits under that same banner, largely because of the failings of some state government budgets. High-growth areas are not seeing physical infrastructure keep pace with the demands that are being placed on the public health system in New South Wales, and on the North Coast in particular. To make my point: the Port Macquarie Base Hospital was built in 1992 for a maximum capacity of presentations to the emergency department of 14,000 people per year. Last year it had over 30,000 presentations. So the maximum capacity of presentations to the emergency department has more than doubled. It is at breaking point. That is exactly why we have put a submission to the Health and Hospitals Fund to try to get that question of an expanded emergency department and intensive care unit addressed, because people are going to continue to move to the North Coast. Unless government keeps pace, we will have to put up the ‘house full’ sign on the North Coast. If the physical infrastructure, and the health service delivery in particular, does not keep pace, we have got some real, chronic problems on our hands with the delivery of health care.
So, once again, any changes that might introduce more pressures to that public hospital system, which is already under pressure in high growth areas such as mine, is unwelcome. Once again, it will be a watching brief from my perspective. But if there is a sniff that this sends those presentations to the public emergency department or to the waiting lists for elective surgery any further through the roof than they already are, then it is a conversation we will continue to have with the Minister for Health and Ageing and the government generally. This is a particularly sensitive issue for an area which has the most elderly demographic in the country, has high growth pressures, is a low SES area and really needs government to step up to the plate on the delivery of public health services. When it does not step up to the plate, any changes to private health insurance are a cause for great and significant concern.
My final point is really a question to the government and relates to revenue. For the out years of 2012-13, I am reading that as a spend of $680 million a year compared to the immediate savings in 2009-10. If this is a decreasing rebate across the three tiers and an increasing surcharge across the three years, I would be very interested to hear an explanation of the maths from the government. If this is a savings measure, then obviously some questions will be raised about where those savings are found. Is this an expansion of incentives or is it not? Is this an expansion of pressures on the public system or is it not? I may be reading those figures incorrectly, but the way I read them leaves open some questions about the very name of the bill—whether it is a fairer private health insurance incentive—and the question of how, if across the three tiers we are seeing general decreases in rebate and increases in surcharge, those maths add up with the forward years as they are presented in the revenues. I would love to hear the minister’s response, if she is going to respond, and I will continue to watch the implications of this legislation. I accept it is part of the government’s general mandate and the means-testing philosophy that we are seeing from this government, but I am very conscious of the pressures arising from an expanding population base on the mid-North Coast that is not seeing an equivalent rate of expansion in the public health system. Therefore, it is more than likely we will be having another conversation with government about this and about health reform generally.