Andrew Giles (Scullin, Australian Labor Party) Share this | Hansard source

A very hard life and it is getting harder, Parliamentary Secretary, for me, but more importantly for many of the people that I represent and the people that the member for Calwell represents due to the changes and broken promises effected by this government. It should have been Medicare's 40th birthday this year. In 1973 the Whitlam government enacted Medicare and transformed access to health care for Australians. It should have been Medicare's 40th birthday and it would have been but for the actions of another conservative government. So whatever members opposite say about their great friendship with Medicare—the health minister and the Prime Minister himself, who was a former health minister—opposition to it and to universal health care is in their DNA. So it seems pretty clear to me that this bill is an expression of their ideology. Talk of sustainability of the PBS and of sustainability of our health system more generally is a very unconvincing fig leaf—or maybe it is just a shorthand for Americanising health care in Australia, walking away from universality by using weasel words.

The changes before us are part of a deeply ideological campaign to get rid of Australia's universal healthcare scheme and to create a two-tiered, user-pays system of health care in Australia. I am mindful, even if the minister is not, of the warnings from most of Australia's most senior doctors that the changes in this budget, of which these measures are only a part, will put back Australia's health system over 50 years, so again under this government we go back to the future; back to the imagined golden age of the Prime Minister's childhood; back to before Whitlam and back to before Medicare's first iteration. I wonder if this explains the health minister's apparent deep interest in matters of history—distant history, of course; he is not very interested in talking about his performance in the last parliament as a silent shadow minister. Perhaps if he had engaged more in the debate over that time we might have been better placed now, as this government considers how it will meet our health challenges.

The minister has a lot to say about the past. Apparently he has a deep interest in health debates under the Hawke government, more than 20 years ago, but he has very little to say about future challenges. As the shadow minister, the member for Kingston, just said, we see lazy policy from a lazy minister who was of course a lazy shadow minister. He seems to be entirely uninterested in facing up to the real challenges in his portfolio. There has been discussion on this side of the House about the challenges in preventative health, and all we have seen is this government—to be fair, they have been consistent with this—walking away from preventative health and pushing people into the expensive tertiary end of the spectrum. In the matter of public importance discussion yesterday, in the minister's 10-minute contribution I am not sure he spent two minutes talking about his portfolio. He was much more excited about showing his contempt for nurses and their representative organisation and discussing at some length his imagined view of how Labor Party preselections are conducted—matters a long way from the very serious matter of public importance before the House yesterday and the challenges we are discussing here today.

If the minister were interested in facing the sustainability challenge, that narrow element of challenge in his portfolio responsibilities, he would have come up with an alternative—the sort of alternative most of the academic contributors to this space have been talking about, like changes to pricing arrangements. Since 1948, some time before Medicare, the Chifley Labor government enacted the PBS and since then it has worked effectively to provide Australians with affordable access to necessary medicines, with the government subsidising those medicines to ensure access based on need. It meets health and economic imperatives. I note that earlier this month the OECD recognised that Australia's pharmaceutical spending as a percentage of health expenditure was below average.

This bill would increase the Pharmaceutical Benefits Scheme co-payments for general patients by $5 to $42.70 and by 80c to $6.90 for concessional patients from 1 January. next year—less than six months time. It also increases the concessional PBS safety net threshold by two prescriptions per year and the general safety net threshold by 10 per cent each year for the four years from 2015 to 2018. I note that there are changes to the Repatriation Pharmaceutical Benefits Scheme as well. These increases are in addition to the usual increases through CPI and indexation and will create many real budget emergencies for families in the Scullin electorate and right around the country.

In considering this bill I have had regard, as I am sure members opposite would have, to the work of the Parliamentary Joint Committee on Human Rights. It noted in its evaluation of the bill:

… the effect of the Bill will be to increase the cost of medications for all consumers, including those reliant on social security payments.

It went on to say that the proposed measures represent ‘a limitation on the right to health and/or a retrogressive measure which is not explicitly addressed in the statement of compatibility for the Bill.’ The committee went on to comment that it would expect a statement of compatibility to provide an economic assessment of the impact of the bill on individuals and their capacity to bear the additional up-front payments for medicines—a not unreasonable request, you might think. The committee has also requested the minister advise further as to the purpose of the proposed measures and whether they can be considered reasonable. I note that the minister is in the chamber, and I await his response.

I have also been mindful of the response of stakeholders. Unsurprisingly, the Pharmacy Guild of Australia has concerns. I note with greater interest, with all due respect to the Pharmacy Guild, the comments of the Consumers Health Forum, which has expressed its deep concern over growing out-of-pocket costs. It strongly opposes these changes, looking to some significant American research indicating that where there is a co-payment people could be four to five times more likely not to have prescriptions filled than when there is no co-payment. These concerns are also echoed by the Public Health Association of Australia, and Michael Moore, the CEO of that organisation, has stated that the measures are inequitable and would affect society's most vulnerable members. He goes on to argue that the people to whom this is most important are the vulnerable, such as Aboriginals and Torres Strait Islanders, people from low socioeconomic backgrounds or from non-English-speaking backgrounds, and the elderly. These very significant concerns should be considered seriously in this place and in the other place should the bill proceed from here.

I note that the bill is expected to raise $1.3 billion over the forward estimates, and that this would be contributed to the government's much vaunted Medical Research Future Fund. The purpose to which these moneys are to be attributed is an important aspect of this debate. It seems to be a reverse hypothecation and it bells the cat on the claims of system sustainability justifying these changes. If it were really about sustainability of the health system, the revenue would be going back into funding health care today and not looking to the sick today to fund future research.

As the member for Kingston and other speakers on the Labor side have noted, Labor made changes to the PBS in government that put it on a sustainable footing. The changes before us are an unnecessary impost on Australians struggling to make ends meet due in large part to other budgetary decisions of this government. Labor's approach looked to the evidence—it looked to proper consultation and had regard to stakeholders, unlike the approach of this government and this minister. These changes will have a real impact on people's lives—unfilled prescriptions on top of doctors visits deferred due to the GP tax.

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