Wilson Tuckey (O'Connor, Liberal Party) Share this | Hansard source

This Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 is important legislation, notwithstanding its minor nature, in as much as it extends the accreditation processes associated more particularly with non-radiology services such as cardiac ultrasound and angiography, obstetric and gynaecological ultrasound, or nuclear medicine imaging services. Of course, when one is dealing with public health and people’s welfare, having these very expensive pieces of equipment operated by properly accredited operators must make a lot of sense, and the opposition welcomes this initiative to extend from scheme 1, which was introduced in 2008, when the accreditation arrangements only covered practices providing radiology services. We are now expanding the accreditation regime. It is not to be implemented until 1 July but there is to be a deeming provision, which is also a very sensible approach to taking up early opportunities for the operators to get accredited.

It is, nevertheless, an opportunity also in discussing this matter to look at many other issues relating to health services. I noted that the member for Dobell, who spoke earlier in this debate, was running the line that during the years of the Howard government nothing was done. I mean, it has got so repetitive it is an outrage. The Minister for Health and Ageing should go back to her office and have a look at herself on television and listen to herself as she carps away day after day after day attacking the opposition for its past faults when of course whatever they might be—and I reject that there were faults—they knew about those when they made their promises at election time. In fact, in government and as a leader of the opposition the Prime Minister made all sorts of promises about how he was going to fix the health system.

I found it quite interesting that the member for Dobell mentioned the $1 billion that was apparently removed, pulled back, from the hospital system. He never mentioned the GST and the massive revenues that that has delivered to the state governments. He never mentioned the fact that the Labor Party opposed it bitterly and, might I add, in a political sense. I hear them from time to time saying, ‘You only say these things to play politics.’ Play politics! The GST, or VAT as it is known in many parts of the world, is a universally proven means of raising consumer taxes that removes a lot of the silly things relevant to sales tax and other methods of consumer taxation. They came in here day after day with kids’ clothing and cream cakes and vegetables attacking the GST. Politically, that was successful. The Howard government lost something like 18 seats in the subsequent election. Remember that they went to the Australian people and said if you re-elect us we will bring in a GST. And we told them in detail what it would apply to, what the charge was going to be, 10 per cent, and so on.

The other thing that was said at the time was that whatever amount of money was to be raised through this taxation would be given to state governments—lock, stock and barrel. The Commonwealth takes all the odium, the Liberal Party lost a lot of seats and gave all the money to state governments. Why did we do that? To quote Prime Minister Howard at the time, it was so that the states had a growth tax, which it certainly demonstrated that it is, and it was to allow them to get on with their principal responsibilities of health, education, and law and order. But that is never counted. It is never counted in education and it is never counted in health. It has a growth characteristic, it is not specific, and unfortunately it was given to state governments without any instruction how to spend it. The then opposition made another big issue about the blame game: don’t blame the states; it is all our fault—the Australian government’s. One of the promises made by the then Leader of the Opposition was, ‘If I can’t get the states to fix it, I will take it all over myself.’ That would be an interesting issue of the economy because, as I said, the GST was provided, with great political pain, to the states primarily to assist them in running their hospitals.

I do not know how this agreement will come out if there is to be additional funding coming from the Commonwealth. But, again, what happens: do they get some of the GST back? The GST was supposed to also cancel out some rather nasty and unproductive state taxes. The states just did not do that; they just took the money. And now they are arguing amongst themselves as to who gets too much and who does not get enough.

The reality is that that money has never been counted in. There was that disgusting ad by the teachers union, with the Comcar driving past the little public school kids, suggesting that the Prime Minister was there. Taking into account the specific grants that relate to private sector education and government schools, no account whatsoever is made of the contribution of the Australian taxpayer, the consumer, through the GST, which does not go to private schools but goes in spades to public schools. Anybody who wants to check the record historically and over time will find that the Australian taxpayer, through the services of this House, pays about 50 per cent of the revenues of every state government in Australia—maybe 48, maybe 51.

So how can it be that the Australian government under John Howard paid less than half the costs of the states in running their hospitals? How can it be otherwise? Yet we get this chatter every day from a minister who cannot point to one improvement in the delivery of health services, who tips buckets all over us in her nasty, catty way. As I said, she should go and listen to a recording of herself in this place. The fact of life is that she cannot point to one improvement. She can point to all the money they have spent. The Prime Minister gets on it. I refer to it as a process of measuring excellence by expenditure.

The member for Dobell, as he ran out all the issues, said, ‘We have done great wonders with superclinics.’ I think he said he has got one in his electorate—in temporary premises. After two years I think there are only two functioning superclinics in Australia. But there is all this money ready and waiting to be consumed for that process. We have invested in this, we have invested in that, we have invested in something else: where are the results? Where are the shorter waiting lists? They are longer. Where is the total removal of instances of elderly persons and others who have fallen over and broken their leg being put on a trolley in the corridor for a lengthy period without assistance? Surely the promise should have been: ‘I will stop that.’ It is about time this government learned that you do not fix health by chucking money at it.

The member for Dobell had his list of criticisms and another myth—that the Howard government discontinued the Commonwealth Dental Scheme. The Keating government’s Commonwealth Dental Scheme went for four years and it was Paul Keating who said publicly: ‘John Howard is mad to give the states untrammelled access to the GST. He will get no value for the Australian taxpayer by so doing.’ He brought in a cash payment to the states to get rid of the waiting lists for public dental services. What happened? Did the states go and hire $200 million worth of dentists or dental nurses? No, they did not. In fact, I think if anyone checks the record they will find that they hired hardly any more. So where could the additional services be? The money disappeared straight down the hole. Of course at the end of it the Howard government could see that the waiting lists were just as long and nothing had been achieved, so we stopped it. And we agonised over it in our party rooms, as you, Mr Deputy Speaker Schultz, would know. Elderly people with severe dental problems were unable to get into the state services funded significantly by the Commonwealth—50 per cent—in the normal course of events.

We said, ‘It’s no good going back.’ We checked the numbers. There were not enough dentists flowing out of the universities who wanted to work for state governments. So if you just gave them the money, the service was not going to improve. So what did we do? Isn’t it interesting. We are virtually, through accreditation, improving the opportunity for people to gain services from the various imaging technologies through Medicare. The Howard government said, ‘We will create a Medicare number for dental services.’ It was not universal but it was done in a way so that people with very serious problems could go to their GP, get a referral and go and spend $4,000 with any dentist—the ones that were in practice, the best—which those people deserved as much as anybody else.

What was the response of this government when they came into office? They came in here with a piece of legislation to take us back to the bad old ways, and they are still whinging about the fact that all of the opposition parties in the Senate opposed that shift—the Greens, the Independent members and the coalition. Why? Because they all knew that that other proposal would not work. But, of course, it would have saved them money. These are the people who said, ‘We will spend as much as is necessary to give people the health services they need.’ The solution is good and it was the proper solution. But it did not stop the member for Dobell carrying on about it as some criminal act against elderly people needing dental services. They are getting them—not for the odd filling—and they were not getting any of them under the old system. So why did that have to change? It is a good policy.

Then we had the promise of all promises. We said, ‘You can’t trust Labor with health.’ Under Blewett they got to the precipice of destroying the private health system and that was their policy. And it was the Howard government which could see this system crashing down—and I want to come back to a special example in that regard—and we started subsidising persons, typically at 30 per cent, who chose to take on private health insurance, other than for some people over age 70 and 75. That means the person involved pays two-thirds of their costs of health services. That is a bad idea, despite the fact that they might be wealthier, on high incomes. And, when you take the rebate away, they will keep paying. I gave an example in an earlier speech today. A former Prime Minister of Australia, Paul Keating, boasted that he never had private health insurance. Why would he bother? Because, when his wife got sick, surprise, surprise, she ended up in a private room in an ACT hospital with surgeon of choice. I gave an example of a speech I heard from a leading administrator of health services in New Zealand, who said, ‘Waiting lists are part of the process of managing the budget of a public hospital.’ He then went on to complain about the administration of waiting lists and how they could be rorted and how, because of the good nature of a member of parliament, they could get people jacked up the list. It should not happen, not if it is true—and of course there is an example of that currently floating around.

The facts of life are that private health contributors pay two-thirds of their health costs. But, again, when we were told that there was a probability that the administration of public hospitals would be taken over by the Commonwealth I had to have a bit of a giggle because, as shadow minister for veterans’ affairs, I watched the Keating government dispose of the Veterans’ Affairs repat hospitals. They gave them away to the states, and two states—Western Australia and Queensland—said, ‘Thanks, but no thanks.’ The Ramsay Health Care group stepped into the breach, and I had representations from RSL members in WA, saying, ‘Wilson, how are we going to manage with nasty private enterprise?’ Three weeks later they said, ‘Wilson, don’t say a word; this is the greatest thing for us since sliced bread.’ Ramsay had reopened the hospital kitchens. The generous Australian government gave the veterans frozen TV dinners. The waiting list for a veteran to have elective surgery at the Hollywood repat hospital in Perth was 10 months. How did Ramsay Health Care fix that? They opened up their operating theatres on a Saturday. They got rid of the hospitals.

The Australian government saved $1 billion by giving away those hospitals. That was how much extra it cost the Commonwealth to run six hospitals. They were run thereafter, but the Commonwealth still paid for them. But they paid a fee for service, as do private health contributors. Take it from me: the bigger the subsidies we pay for people to go into private health the less money it will cost the Australian taxpayer and of course the service will be better. There is a fundamental in public hospital funding—it is called the block budget. The hospital is given a budget and that makes a patient a liability. You cannot have too many of them! They cost you money; they erode your budget. And you wonder why there are waiting lists. You wonder why people cannot get the orthopaedic items they want for hip joint replacements and all those sorts of things. That is the issue. The system is wrong, and I get angry about this. I watch people throwing money at a system that will never work in the shape it is currently in. Yet I watch people with a culture, with a philosophy that, if it is not run by the government, it is no good, thereby undermining a system that brought private health membership up to almost 50 per cent when it was just about to fall over and that gave people the right to pay two-thirds of the cost and to access medical services when they needed them. That is why, if there is any move by the Rudd government to make deals with the states, the ongoing system will not work.

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