Terri Butler (Griffith, Australian Labor Party) Share this | Hansard source

I oppose the bill, which is one that increases the Pharmaceutical Benefits Scheme co-payment for general patients by $5 to $42.70 and by 80c to $6.90 for concessional patients, from 1 January 2015. The bill also increases the concessional PBS safety net threshold by two prescriptions per year and the general safety net threshold by 10 per cent per year, each year, for four years from 2015 to 2018. The additional fees for PBS co-payments will be in addition to the usual increases for CPI. We are told the bill is expected to raise $1.3 billion over four years and will contribute toward the Medical Research Future Fund that the government announced in its 2014-15 budget.

The opposition opposes the bill. The bill is one that will have a disproportionate effect on those least able to shoulder the burden on this government's cruel budget and its twisted priorities. This is a government, in its budget, that wants to introduce new charges for going to the doctor, new charges for going to imaging services, new charges for pathology and increased charges—as we are seeing in this bill today—for prescriptions.

Part of the reason I wanted to speak on this bill is it really exposes some of the difficulties with the GP tax. We are told it is a $7 tax. We are told that $7 is a small amount of money. Of course, $7 is not a small amount of money for people on lower and middle incomes, particularly for people who might have one or two people sick in the family at one time or for those, like me, who are the parents of young children. I understand the Treasurer said on television a little while ago that it would be unusual for more than one child to be sick at any one time. With respect to the Treasurer, I disagree. I think it would be more unusual if all the kids in the family did not get the cold or flu or pick up the same virus or illness at the same time.

It is obviously a very concerning amount of money, at $7. More to the point, no one should be under any illusion about the Liberal-National government's preparedness to increase co-payments by greater than the CPI. That is what they did with the PBS co-payment increase in 2005 and it is what they are doing now with this bill. They are increasing the co-payment by greater than the CPI. Some of them are not explicitly stated, but the reasons for the co-payment, in each case, is to send a so-called price signal. What is a price signal? It is a signal to people not to go to the doctor. It is a signal to people not to fill a prescription.

The Liberal-National government is implying that people are unnecessarily going to the doctor or are unnecessarily filling prescriptions. In other words, the government is calling Australians hypochondriacs. I do not believe Australians are hypochondriacs and nor should I believe it. There is no evidence to that effect. At the end of Terry Barnes's submission to the Commission of Audit, in which he contended for a co-payment on GP visits, he acknowledged that he did not have any research that indicated Australians were unnecessarily seeing doctors. In many ways, this idea of a price signal is putting the cart before the horse. Surely before a government engages in a reckless policy of dissuading people from seeking medical assistance, that government ought to have evidence that people are unnecessarily seeking medical assistance. If there was such an issue and if the government had that research—and if it did, it would have clearly told us and come clean with the Australian people—then the government would have, if it were responsible and not reckless, created or crafted policy responses to deal with that specific issue rather than have this reckless policy that will see people who are in need of health care not seeking that assistance early or possibly at all. A well-respected academic, Professor Stephen Duckett, a professor of health policy at La Trobe University and a director of the health program at the Grattan Institute, said:

The effects are known: budget savings will be made—over $1b a year—off the backs of the poorest and most vulnerable. People who miss out on the safety net will now miss out on care as well.

That is what Professor Duckett said about the GP co-payment on The Conversation website, which is known to many people in this place.

Those concerns are backed by the evidence and the facts, which is what public policy ought to be based on, instead of ideology and liberal and national ideas that they need to somehow get poor, low- and middle-income people to stop going to the doctor and to stop filling prescriptions. The facts are as follows. The COAG Reform Council report released in early June found that 8.5 per cent of people in 2012-13 delayed or did not fill their prescription due to cost, in disadvantaged areas this figure was 12.4 per cent and for Indigenous people this figure was 36.4 per cent—that is, over one-third of Indigenous people did not fill their prescriptions because of cost.

The last time a Liberal-National government increased the tax on medicines, in 2005, prescriptions for some essential medicines fell by as much as 11 per cent. I am sure academics in Western Australia have been studying very closely what effect price increases have had on prescriptions being filled. We know what can happen when so-called price signals are sent. They have the exact effect that is intended. The intended effect is that people do not fill their prescriptions. The effect of the GP tax, the imaging tax and the blood test tax will be that people will not get that medical help. That is the entire intention of the co-payments.

We hear from the government all this language around sustainability. The money is not going back into Medicare; the money is going to the medical research fund that the government wants to establish. They say this is an improvement to the sustainability of health spending in this country. It is obviously not about revenue into Medicare; it is obviously about expenditure from Medicare—in other words, dissuading Australians from going to the doctor, from getting X-rays, from getting blood tests or, in this case, from filling their prescriptions.

I cannot think of a more reckless policy than a policy that prevents people, that dissuades people and that reduces people's propensity to get medical assistance when they need it. There are enough impediments. There are attitudinal impediments. There are already difficulties in getting people to see doctors and to take their medicine when they need to. We do not need a policy that prevents people from getting medical help. We need a policy to help people get more medical help when they need it and to go to the doctor earlier—not ignore that feeling that something is wrong but actually get themselves checked out. We need to support preventative health measures, but this government wants to abolish the Preventive Health Agency. We need health reform that is aimed at planning the health workforce for the future. We know that there is going to be increasing demand for health workers, yet the government wants to abolish the workforce planning agency.

When it comes to pharmaceuticals, we know that this is a $1.3 billion tax increase on medicines that will hurt every Australian. This is part of a campaign by this government to create a two-tier user-pays health system. Doesn't that work so well in the United States? Aren't they pleased with their health system? The United States is one of only three countries in the OECD where a greater proportion of healthcare costs are borne by private funding sources than by public funding sources. Let us look at what has happened there. Health inflation has risen sharply over the past 30 years, much more sharply than general inflation, and the price of health goods has also risen sharply. Why would we want to follow the lead of a country that spends nearly 18 per cent of its GDP on health care when we spend in the vicinity of nine per cent of GDP on health care? Why would we want to Americanise our health system? The answer is simple: we do not want to Americanise our health system. Australia has a health system that is the envy of the world. The Australian health system is based on the principle of universality—everyone has access to the health care they need.

Yesterday in question time the Minister for Health mentioned that the purpose of bulk-billing was to be a safety net. That betrayed the Minister for Health's fundamental misunderstanding of our health system. Bulk-billing underpins universal health care in Australia. Bulk-billing is an important and fundamental part of our health system. It is not a safety net in a two-tier health system. We do not have a situation in this country yet where your income determines the quality of the health care that you can get. We do not want it to become the case that your income determines the quality of the health care that you get. But this move to increase the PBS co-payment by greater than the CPI, the new tax on GP visits, the new tax on imaging, the new tax on pathology—all of these things are aimed at creating a two-tier health system and aimed at shifting the funding of healthcare costs in this country further towards private sources and away from public sources. This is not something that the Labor Party will support. It is, as I said, a $1.3 billion tax increase on medicines. We will oppose it.

We say that it is not appropriate to ask the sickest Australians to fund this government's medical research foundation. We know it was a hurried policy—the government has admitted as much. We know that just a few weeks before the budget was handed down the policy was created. We also know that it is ill-considered, because it is a policy that robs today's sick to pay for research to help tomorrow's sick. It is a policy that asks the sickest Australians to fund the creation of a medical research foundation. The problem with policy on the run is that, apart from the fundamental difficulties with the policy itself, it does tend to lead to unintended consequences. We have already seen one of the health research bodies warning that it has received a number of communications from donors to say that they were no longer going to contribute to health research in this country because of the establishment of this fund. It is part of the risk of rushing through policy without thinking it through—it is policy that is motivated by ideology, not by evidence or by sound reasoning.

Labor is also concerned that some of Australia's most senior doctors have been speaking out against the Abbott government's co-payment plans. People from diverse sources are worried. In my own electorate I have been visited by health stakeholders, including the Doctors Reform Society, who have expressed grave concern about the changes to the health system. I have had constituents write to me concerned about the new GP tax. Just today I received a message from a constituent, David, on Twitter who said he received a text message from a local health service provider, advising that there was not yet a co-payment on their services. What would motivate a health service provider to send that text message to its patients? Obviously, the co-payment is already having the intended effect of dissuading people from using health services. The health service provider is trying to counteract that effect for their business. We on this side of the House consider it wrong and reckless to put in people's way obstacles to seeking the health care they need.

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