Jenny Macklin (Jagajaga, Australian Labor Party, Shadow Minister for Families and Payments) Share this | Hansard source

First of all, I am making these remarks on behalf of the opposition. Our shadow health minister is unable to be here tonight but I commend her for the outstanding work she is doing in making sure we continue to have a strong universal health insurance system in this country. I move:

That all words after 'That' be omitted with a view to substituting the following words: 'whilst not declining to give the bill a second reading the House notes that the bill is one of many changes the government is proposing that will increase the cost of healthcare.'

The changes contained in this bill need to be considered in the context of the substantial overall changes to our health system. What this bill proposes is relatively simple, but these changes are not occurring in isolation. They are changes that bear some scrutiny because they are from a government that has no vision of how to improve Australia's health system but is intent on creating a two-tiered, user-pays health system.

In opposition, the now Minister for Health was hardly to be seen. He was certainly not seen making any meaningful contribution on health policy. Having now come to government with no plan whatsoever of how to improve Australia's health system, the minister's indolence has been exposed. This government does not have a plan for Australia's health system; instead it sees it as a cost to be eradicated. If this government does get its way, it will see almost no role for the Commonwealth in health care.

The Commission of Audit developed the blueprint for this ultraconservative agenda in its recommendation to exclude high-income earners from accessing Medicare, leaving it only as a residual system for the poorest of Australians rather than the universal insurance scheme it is respected as today. These are concerns that are not solely held by Labor. Indeed, the former Vice President of the Australian Medical Association, Professor Geoff Dobb, described the changes this government wants to make to Medicare as setting health care in Australia back more than 50 years. The current President of the Australian Medical Association, Associate Professor Brian Owler, has been similarly critical of this government's attempts to wreck the health system. Writing in the Sydney Morning Herald on 18 June this year, Associate Professor Owler said:

The health measures in the federal budget are almost universally opposed by the people who provide health services in Australia … The message is clear: the measures add up to bad health policy.

He goes on to say:

The health of Australians is too important for healthcare to be an ideological toy.

It does take a uniquely inept health minister to manage to unite the entire health sector against the government; but the poor policies, lack of consultation and ideological agenda this government has brought to health policy has resulted in exactly that. Dr Stephen Duckett, a respected health economist and former health department secretary, who is now the Health Program Director with the Grattan Institute, said in May this year:

Pre-budget softening up does not obscure the harsh reality of the 2014-15 budget decisions. Bulk billing is gone, health reform agreed by all states and territories is demolished, funding to the states is slashed and promises are broken.

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.

Likewise Mike Daube, a professor of public health at Curtin University, said:

This is a distressing Budget for anyone concerned for the community's health. Among the massive health system cuts and increased personal health costs, the once modest funding for prevention has become almost invisible.

The loss of the National Partnership Agreement for public health will mean cuts to important programs around the country dealing with obesity, cancer prevention, diabetes and other conditions that result in massive costs to the health system.

Increased health care costs for individuals will discourage people from seeking medical help—resulting in more preventable and expensive health problems.

Adam Stankevicius, the Chief Executive Officer of the Consumer Health Forum, the group that represents consumers in the health system including some of the poorest and most vulnerable in the community, did not mince his words:

This is a retrograde health budget that will shock Australians who thought this government was the best friend Medicare ever had.

It is important to appreciate the context within which this budget measure is being considered. We are not looking at a one-off increase in out-of-pocket costs but a coordinated campaign to undermine Medicare and relegate it to a safety net for only the poorest in the community. The campaign by this government is well underway: a $7 tax on GP visits that will hit the most vulnerable in the community; a tax on pathology tests; a tax on diagnostic imaging; a $1.3 billion increase to the cost of medicines; and unfair changes to the safety net that will see the safety net increasing by 10 per cent, plus the consumer price index, every single year for general patients and for two scripts per year for concessional patients. The effect of these changes will not only be that pensioners will have to pay an extra 80c for every script; by 2017-18 they will have to fill 68 scripts before they even reach the safety net.

There is also a proposal to bully the states into putting a tax on emergency department visits that will only penalise very sick Australians, who avoid hospital because they cannot afford it, potentially leading to catastrophic consequence. And of course there is the decision to cut more than $50 billion from Australia's public hospitals, a decision that will see the Commonwealth providing the lowest level of hospital funding in Australia's history and an inability for states to actually meet the required level of funding for hospitals.

South Australian premier Jay Weatherill has said that the cuts are the equivalent of ripping $655 million from South Australian public hospitals, which is the equivalent of closing the Flinders Medical Centre—the second-largest tertiary hospital in his state—or the equivalent of getting rid of more than 600 hospital beds, sacking 3,000 nurses and doubling the elective surgery waiting time. We know from evidence given by the South Australian department of health before the Senate Select Committee on Health that the impact of the GP tax on emergency departments will be an additional 290 emergency department attendances, costing the state an additional $80 million.

A New South Wales health document showed a similar impact, with the department there having modelled an additional $500,000 emergency procedures a year because of this retrograde step. On the specifics of the bill before us today, the Private Health Insurance Amendment Bill (No. 1) 2014 amends the Private Health Insurance Act 2007 to pause the income thresholds that determine the tiers for the Medicare levy surcharge and the rebate on private health insurance at 2014-15 rates for three years. What this will mean is that individuals and families with incomes marginally below each threshold will reach the higher threshold sooner.

The bill is to raise more than $599 million in the financial years to 2017-18, but these savings will not contribute to a greater investment in the health system. This does completely undermine the government's argument that spending on Medicare is unsustainable; the basis of its intention to break its election promise that there would be no cuts to health and no new taxes, while they introduce a GP tax. Instead of being reinvested back into improving Medicare, the $599 million to be saved as a result of this bill will contribute to the still-to-be-established Medical Research Future Fund.

Labor of course is the strongest supporter of health and medical research in this parliament. We demonstrated this support in government through a record commitment of more than $3.5 billion in health and medical research funding, including more than $700 million to build and upgrade health and medical research facilities across the country. But the Medical Research Future Fund is emblematic of the dysfunction of this government. We know that the Department of Health became aware of the fund only a matter of weeks before its announcement. The National Health and Medical Research Council had no idea the fund was to be established until budget night, and accordingly had no say on its development. Likewise, the CSIRO and Australia's Chief Scientist knew nothing about the fund until budget night.

This truly is the government's 'hollowmen' moment. Something dreamt up in the weeks before the budget to distract from the horrid landscape created by a budget that includes the $3.5 billion GP tax, a $1.3 billion increase to the cost of medicines and unfair changes to the safety net, more than $400 million in cuts to dental programs, and cuts of $57 billion to Australia's public hospitals that started on 1 July this year.

It shows how uniquely arrogant and incompetent this government is that it cannot, after only a little more than a year, recognise the damage it is doing; and frankly it ought to be ashamed. If one is to look at what this government promised before the last election, and what it is doing now, all that needs to be done it put a 'not' in every promise that was made.

They said, 'No cuts to health'. That promise was broken even before the budget when the government made a decision to cut $264 million from the Priority Health Initiatives, including: $100 million for the redevelopment of Westmead Hospital; $12 million from the Millennium Institute at Westmead; $10 million from the Children's Medical Research Institute; $10 million from Nepean Hospital; $22 million from St George Hospital; $6 million for MRI in Mt Druitt; $10 million for the Queensland cancer package; $3.5 million for Biala Health Service; $15 million for Flinders neonatal unit; $10 million for the WA cancer team; $15.1 million for cancer care coordinators; and $50 million for the stroke package. All of this is gone as a result of this government's cuts.

And, despite promising 'no new taxes', we know the government remains intent on forcing a $3.5 billion tax on every Australian. But this is much more than just a tax on GP visits. We learned in question time last week that the Prime Minister did not even know what the impact of the abolition of bulk-billing incentive payments would be on medical imaging. A day later, the Prime Minister was finally briefed by his absent minister that the government estimated a one per cent reduction in the number of medical imaging services because of the GP tax. What that means in practice is that there will be more than 600,000 fewer medical imaging services in the first year—X-rays, MRIs, CAT scans—all of this, because of the dramatic change that this government is trying to implement.

The Australian Diagnostic Imaging Association, that previously on occasion bulk-billed patients, is now saying that people will face up-front costs of up to $1,263 for a liver cancer diagnosis, $1,326 for a thyroid cancer diagnosis, $2,207 to diagnose liver metastasis and $712 to diagnose breast cancer. These costs are obviously so prohibitively expensive that it should come as no surprise that the government is estimating such a large reduction in the number of medical imaging services: up to 600,000—or even more than 600,000—fewer medical imaging services because of this new tax. On this side of the parliament, we have very grave concerns that because of this very poorly-conceived policy many Australians will avoid services like MRIs, X-rays and PET scans simply because they cannot afford them. The consequences of doing so could be deadly.

The changes proposed by this government stand in stark contrast to the way in which Labor, in government, was able to make responsible changes and to find savings without gutting Medicare. Most significantly, of course, was the decision to means test the private health insurance rebate—something that the now Minister for Health was and remains extremely critical of. But, unlike the Minister for Health—who wants to introduce a GP tax; who has cut $57 billion from public hospitals; and who is seeking to privatise Medicare, creating a two-tiered American-style health system—the changes that Labor made to the private health insurance rebate, including means testing that rebate, will improve the budget bottom line by more than $20 billion in the decade to 2023-24.

In his contribution, the then shadow minister for health, the now minister, said:

Betrayal is becoming a constant of this government and certainly of this Prime Minister …

The minister then gave a righteous contribution that referred to promises that were 'clearly not worth the paper they were written on'. It is worth reflecting again on the context of these changes that we are now looking at and which have been put forward by this government, reflecting on the fact that the promises were certainly not worth the paper they were written on.

In his contribution to the debate on the bill to means test the private health insurance rebate in 2012, the member for Dickson, the now minister said:

In our country we have a universal health system. That means that, regardless of whether you earn one dollar or a million dollars a year, if you have a heart attack, are involved in a motor vehicle accident, have a crook hip, need oncology treatment or whatever, you can turn up at a public hospital and demand treatment free of charge. That has been an underlying principle supported by both sides of this parliament for a very long period of time—and long may that be the case. A universal system says to people that, in a country like ours in the 21st century, the best available services will be provided.

Well, what hollow words from this minister, who has launched the biggest attack on Medicare since it was first established!

I refer, of course, to the 'Coalition's policy to support Australia's health system' and in particular to the commitment on page 6, which is, in fact, the very first page of the coalition's plan after a long preamble and the usual vitriolic political rhetoric. But it is a very important promise and it says:

A Coalition government will support the transition to the Commonwealth providing 50 per cent growth funding of the efficient price of hospital services as proposed.

But the government will not honour this commitment. In fact it is ripping $57 billion out of public hospitals over the next 10 years. The level of hospital funding proposed by this government, contrary to the promises made before the election, is the lowest level of funding since the Commonwealth started funding public hospitals after the Second World War.

When the private health insurance rebate was means tested, the member for Dickson said:

It is interesting to look at some independent analysis of the changes—the Deloitte analysis, for argument's sake. They predict that, in the first year, 175,000 people would withdraw from private hospital cover and a further 583,000 people would downgrade their private cover. Over five years, they predict that 1.6 million Australians would drop cover and 4.3 million would downgrade their cover.

In fact, that is not what occurred. The number of Australians with private health insurance continues to increase. In fact, it is at the highest level ever, and continued to increase in spite of this change. So Labor was able to make changes that improved the budget bottom line by more than $20 billion without gutting Medicare and without hundreds of thousands of people cancelling their policies as the now minister warned.

When the then shadow minister for health made this assertion, 46.2 per cent of Australians had hospital cover; now, 47.2 per cent of Australians have private hospital cover. And when the then shadow minister for health made this statement back in 2012, 53.7 per cent of Australians had general treatment cover, whereas at September this year 55.2 per cent of the population had general treatment cover. It proves it is possible to make changes to ensure the sustainability of our health system without turbocharging Australia's acceleration towards a two-tier, American-style health system.

The $599.3 million to be saved as a result of this bill will not, as I said, contribute to Medicare or to the sustainability of Australia's health system but will contribute to the still-to-be-established Medical Research Future Fund. As I have mentioned already, Labor continues to be the strongest supporter of health and medical research. We demonstrated this again and again during our time in government and we will continue to do so. Our record in supporting health and medical research is clear, which is why we will continue to demonstrate it so that Australia continues to be a world leader in health and medical research. We want to make sure we do this, but we will not support funding research at the cost of taxing the sickest and most vulnerable Australians today.

Labor will not be opposing this bill but, as I have outlined, we do have very serious concerns about the context in which these changes are being made. They are occurring in an environment where we see the most concerted attack on universal health care in Australia since Medicare was introduced, driven by an ideological agenda to render Medicare a safety net only for the very poorest Australians and not the universal scheme it is today. Labor will stand up against this ideological attack by this government. As the party that introduced Medibank and Medicare, we will defend it, and the next Labor government will strengthen it.

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